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Peña E, Mas-Bermejo P, Lecube A, Ciudin A, Arenas C, Simó R, Rigla M, Caixàs A, Rosa A. Use of polygenic risk scores to assess weight loss after bariatric surgery: a 5-year follow-up study. J Gastrointest Surg 2024; 28:1400-1405. [PMID: 38821212 DOI: 10.1016/j.gassur.2024.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/19/2024] [Accepted: 05/27/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Bariatric surgery (BS) is currently the most effective long-term treatment of severe obesity. However, the interindividual variability observed in surgical outcomes suggests a moderating effect of several factors, including individual genetic background. This study aimed to investigate the contribution of the genetic architecture of body mass index (BMI) to the variability in weight loss outcomes after BS. METHODS A total of 106 patients with severe obesity who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy were followed up for 5 years. Changes in BMI (BMIchange) and percentage of total weight loss (%TWL) were evaluated during the postoperative period. Polygenic risk scores (PRSs), including 50 genetic variants, were calculated for each participant to determine their genetic risk of high BMI based on a previous genome-wide association study. Generalized estimating equation models were used to study the role of the individual's polygenic score and other factors on BMIchange and %TWL in the long term after surgery. RESULTS This study found an effect of the polygenic score on %TWL and BMIchange, in which patients with lower scores had better outcomes after surgery than those with higher scores. Furthermore, when analyzing only patients who underwent RYGB, the results were replicated, showing greater weight loss after surgery for patients with lower polygenic scores. DISCUSSION Our results indicate that genetic background assessed with PRSs, along with other individual factors, such as biological sex, age, and preoperative BMI, has an effect on BS outcomes and could represent a useful tool for estimating surgical outcomes in advance.
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Affiliation(s)
- Elionora Peña
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark; Secció de Zoologia i Antropologia Biòlogica, Departament de Biologia Evolutiva, Ecologia i Ciències Ambientals, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
| | - Patricia Mas-Bermejo
- Secció de Zoologia i Antropologia Biòlogica, Departament de Biologia Evolutiva, Ecologia i Ciències Ambientals, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain; Institut de Biomedicina de la Universitat de Barcelona, Barcelona, Spain
| | - Albert Lecube
- Department of Endocrinology and Nutrition, Arnau de Vilanova University Hospital, Institut de Recerca Biomèdica de Lleida, Universitat de Lleida, Lleida, Spain
| | - Andreea Ciudin
- Diabetes and Metabolism Research Unit, Department of Endocrinology and Nutrition, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain
| | - Concepción Arenas
- Statistics Section of the Department of Genetics, Microbiology and Statistics, Universitat de Barcelona, Barcelona, Spain
| | - Rafael Simó
- Diabetes and Metabolism Research Unit, Department of Endocrinology and Nutrition, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain
| | - Mercedes Rigla
- Department of Endocrinology and Nutrition, Institut d'Investigació i Innovació, Parc Taulí Hospital Universitari, Sabadell, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Assumpta Caixàs
- Department of Endocrinology and Nutrition, Institut d'Investigació i Innovació, Parc Taulí Hospital Universitari, Sabadell, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Araceli Rosa
- Secció de Zoologia i Antropologia Biòlogica, Departament de Biologia Evolutiva, Ecologia i Ciències Ambientals, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain; Institut de Biomedicina de la Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica En Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain.
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Karpińska I, Dowgiałło-Gornowicz N, Franczak P, Orłowski M, Lech P, Kowalski G, Major P. Factors contributing to weight loss success after bariatric procedures in patient over 65 years old: a multicenter retrospective cohort study. Int J Surg 2024; 110:4893-4899. [PMID: 38729122 PMCID: PMC11325908 DOI: 10.1097/js9.0000000000001588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/26/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Although bariatric surgery in patients over 65 years of age gives comparable results to treatment in the younger population, there are still controversies regarding the indications for surgery, risk assessment, and choice between different types of surgery. The study aimed to identify the factors contributing to weight loss success after bariatric surgery in patients over 65 years of age. MATERIAL AND METHODS This is a retrospective, multicenter cohort study of patients with obesity aged over 65 years undergoing primary laparoscopic bariatric surgery in the years 2008-2022. Data came from 11 bariatric centers. Patients were divided into two groups: responders (R) who achieved more than 50% EWL and nonresponders (NR) who achieved less than 50% EWL. Both groups were compared. Uni- and multivariate logistic regression was used to identify predictors of weight loss success. RESULTS Out of 274 analyzed patients, the average BMI before surgery was 42.9 kg/m 2 . The most common obesity-related diseases were hypertension (85.1%) and type 2 diabetes (53.3%). Sleeve gastrectomy was the most frequently performed procedure (85.4%). Uni- and multivariate logistic regression analysis confirmed preoperative BMI (OR=0.9, 95% CI: 0.82-0.98, P =0.02), duration of diabetes >10 years (OR=0.3, 95% CI: 0.09-0.82, P =0.02), balloon placement (OR=10.6, 95% CI: 1.33-84.83, P =0.03), time since first visit (OR=0.9, 95% CI: 0.84-0.99, P =0.04), preoperative weight loss (OR=0.9, 95% CI: 0.86-0.98, P =0.01), and OAGB (OR=15.7, 95% CI: 1.71-143.99, P =0.02) to have a significant impact on weight loss success 1 year after bariatric surgery. CONCLUSIONS Patients with higher preoperative weight loss may have a poorer response to surgery. OAGB emerged as the most beneficial type of surgery in terms of weight loss. Intragastric balloon placement before surgery may be effective in patients above 65 years of age and may be considered as a two-stage approach.
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Affiliation(s)
- Izabela Karpińska
- 2nd Department of General Surgery, Jagiellonian University Medical College
- Doctoral School of Medical and Health Sciences, Jagiellonian University Medical College, Cracow
| | - Natalia Dowgiałło-Gornowicz
- Department of General, Minimally Invasive and Elderly Surgery, Collegium Medicum, University of Warmia and Mazury, Olsztyn
| | - Paula Franczak
- Department of General and Oncological Surgery, Ceynowa Hospital, Wejherowo
| | - Michał Orłowski
- Department of General and Oncological Surgery, Ceynowa Hospital, Wejherowo
| | - Paweł Lech
- Department of General, Minimally Invasive and Elderly Surgery, Collegium Medicum, University of Warmia and Mazury, Olsztyn
| | | | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College
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Barajas-Gamboa JS, Khan MSI, Dang JT, Romero-Velez G, Diaz Del Gobbo G, Abdallah M, Pantoja JP, Abril C, Guerron AD, Lee-St. John T, Corcelles R, Rodriguez J, Kroh M, Uy-Kroh MJ. The Effects of Post-Surgical Pregnancy on Weight Loss Trajectories after Bariatric Surgery: Are Initial Weight and Age Prognostic Factors? J Clin Med 2024; 13:1264. [PMID: 38592078 PMCID: PMC10931694 DOI: 10.3390/jcm13051264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 04/10/2024] Open
Abstract
Introduction: A substantial percentage of patients undergoing bariatric surgery are of childbearing age. Pregnancy outcomes after bariatric surgery are known. However, there are limited data on the impact of pregnancy on weight loss after surgery. Objectives: This study aims to evaluate the effects of pregnancy on post-bariatric surgery weight loss trajectories (WLTs) and to determine the association with age and initial weight. Methods: All who had primary bariatric surgeries (Roux-en-Y gastric bypass or sleeve) between September 2015 and July 2020 were classified into two groups: post-surgery gravid (GG) and post-surgery non-gravid (NG). WLTs were examined using a random intercept mixed-effects model with repeated measures nested within patients. The post-surgery/pre-gravid time phase (PoPG) was modelled using a third-degree polynomial. For GG, two third-degree spline functions modelled the post-surgery while gravid (PoWG) and post-partum (PoPP) time phases. Age and initial weight were used to control for pre-existing differences during PoPG. Weight differences at 6 months PoPP were examined by applying general linear hypothesis testing to the mixed-model results. Results: A total of 508 patients were included, 20 in GG and 488 in NG. The mean age at surgery was 33 years in GG and 37 years in NG. The mean initial BMI was 47 kg/m2 and 43 kg/m2, respectively. During PoPG, adjusted average weight in both groups follows the path across time. For GG, weight decreases and then increases during PoWG. For GG during PoPP, weight immediately decreases after delivery and then increases over time to levels similar to NG. Weight differences at 6 months PoPP for GG and NG were not statistically different. Older age was associated with reduced weight loss during PoPG by Baseline Age, while higher initial weight was associated with increased weight loss during PoPG by Baseline Weight. In both instances, these effects attenuate over time. Conclusions: This model indicates that pregnancy following bariatric surgery affects WLT during PoWG and PoPP, and no difference in weight is expected after 6 months post-gravid. Age and initial weight could be considered prognostic factors during PoPG. Patients wishing to conceive should undergo preconception counselling and be advised to avoid pregnancy during the period of rapid weight loss. They also should be informed that WLT may vary during pregnancy and early post-partum.
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Affiliation(s)
- Juan S. Barajas-Gamboa
- Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi 112412, United Arab Emirates; (J.S.B.-G.); (M.S.I.K.); (G.D.D.G.); (M.A.); (J.P.P.); (C.A.); (A.D.G.); (T.L.-S.J.); (J.R.)
| | - Mohammed Sakib Ihsan Khan
- Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi 112412, United Arab Emirates; (J.S.B.-G.); (M.S.I.K.); (G.D.D.G.); (M.A.); (J.P.P.); (C.A.); (A.D.G.); (T.L.-S.J.); (J.R.)
| | - Jerry T. Dang
- Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (G.R.-V.); (R.C.); (M.K.)
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
- Women’s Health Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Gustavo Romero-Velez
- Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (G.R.-V.); (R.C.); (M.K.)
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Gabriel Diaz Del Gobbo
- Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi 112412, United Arab Emirates; (J.S.B.-G.); (M.S.I.K.); (G.D.D.G.); (M.A.); (J.P.P.); (C.A.); (A.D.G.); (T.L.-S.J.); (J.R.)
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Mohammed Abdallah
- Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi 112412, United Arab Emirates; (J.S.B.-G.); (M.S.I.K.); (G.D.D.G.); (M.A.); (J.P.P.); (C.A.); (A.D.G.); (T.L.-S.J.); (J.R.)
| | - Juan Pablo Pantoja
- Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi 112412, United Arab Emirates; (J.S.B.-G.); (M.S.I.K.); (G.D.D.G.); (M.A.); (J.P.P.); (C.A.); (A.D.G.); (T.L.-S.J.); (J.R.)
| | - Carlos Abril
- Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi 112412, United Arab Emirates; (J.S.B.-G.); (M.S.I.K.); (G.D.D.G.); (M.A.); (J.P.P.); (C.A.); (A.D.G.); (T.L.-S.J.); (J.R.)
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Alfredo D. Guerron
- Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi 112412, United Arab Emirates; (J.S.B.-G.); (M.S.I.K.); (G.D.D.G.); (M.A.); (J.P.P.); (C.A.); (A.D.G.); (T.L.-S.J.); (J.R.)
| | - Terrence Lee-St. John
- Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi 112412, United Arab Emirates; (J.S.B.-G.); (M.S.I.K.); (G.D.D.G.); (M.A.); (J.P.P.); (C.A.); (A.D.G.); (T.L.-S.J.); (J.R.)
| | - Ricard Corcelles
- Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (G.R.-V.); (R.C.); (M.K.)
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - John Rodriguez
- Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi 112412, United Arab Emirates; (J.S.B.-G.); (M.S.I.K.); (G.D.D.G.); (M.A.); (J.P.P.); (C.A.); (A.D.G.); (T.L.-S.J.); (J.R.)
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Matthew Kroh
- Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (G.R.-V.); (R.C.); (M.K.)
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - M. Jean Uy-Kroh
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
- Women’s Health Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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Sobutay E, Bilgiç Ç, Kabaoğlu B, Yavuz Y. Can Weight of The Resected Stomach Predict Weight Loss Results After Laparoscopic Sleeve Gastrectomy? Surg Laparosc Endosc Percutan Tech 2024; 34:29-34. [PMID: 38306493 DOI: 10.1097/sle.0000000000001260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/11/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric procedure worldwide. Many factors have been investigated in the literature to predict weight loss outcomes after LSG. However, insufficient data regarding the resected stomach weight (RGW) exists. This retrospective study aimed to investigate the association between RGW and weight loss outcomes 1 year after LSG. MATERIALS AND METHODS Fifty-four patients who underwent LSG in a tertiary care center were evaluated retrospectively. The statistical analyses were performed to investigate the correlation between preoperative demographics, RGW, and the excess weight loss percentage (%EWL) and percent total weight loss (%TWL). RESULTS The mean RGW was 169.7±40.1, ranging from 101 to 295 grams. The RGW was significantly correlated with preoperative weight (r=0.486; P<0.001), body mass index (r=0.420; P=0.002), and age (r=0.327; P=0.01). However, RGW did not predict postoperative weight loss, as measured by percent total weight loss (%TWL) and percent excess weight loss (%EWL), respectively (r=0.044; P=0.75 and r=-0.216; P=0.11). Multiple linear regression analysis identified age as a negative predictor for both %TWL (β=-0.351, P=0.005) and %EWL (β=-0.265, P=0.03), while preoperative body mass index was a negative predictor for %EWL (β=-0.469, P<0.001). CONCLUSION The RGW, although correlated with patient characteristics, does not serve as a reliable predictor of postoperative weight loss in the first year after LSG. Further research is needed to improve predictive models and patient care in bariatric surgery.
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Affiliation(s)
- Erman Sobutay
- Department of General Surgery, Koç Foundation American Hospital
| | - Çağri Bilgiç
- Department of General Surgery, Koç Foundation American Hospital
| | - Burçak Kabaoğlu
- Department of General Surgery, Koç Foundation American Hospital
| | - Yunus Yavuz
- Department of General Surgery, Koç Foundation American Hospital
- Department of General Surgery, Obesity and Metabolic Surgery Center, Koç University, School of Medicine, Istanbul, Turkey
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Althumiri NA, Bindhim NF, Aldabaeab AE, AlMousa N, Aljabbary R, Alumran A. Comparative analysis of lifestyle behaviors and dietary intake among obese and non-obese individuals following bariatric surgery: a secondary data analysis from 2020 to 2022. Front Nutr 2023; 10:1273164. [PMID: 37964934 PMCID: PMC10642296 DOI: 10.3389/fnut.2023.1273164] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 10/11/2023] [Indexed: 11/16/2023] Open
Abstract
Objective The aim of this research is to perform a comparative examination of lifestyle habits and dietary consumption between obese and non-obese subjects who have undergone bariatric surgery. This is done with the intent of investigating the disparities in obesity outcomes attributable to these elements. Method This study involves a secondary analysis of cross-sectional data obtained from the Sharik Diet and Health National Survey (SDHNS). To ensure a representative distribution of participants, the SDHNS employs a proportional quota sampling strategy, with stratification based on age, sex, and geographic location within Saudi Arabia's 13 administrative regions, utilizing the ZDataCloud® system for this purpose. The data, collected between 2020 and 2022 from over 15,000 participants, were screened to identify the eligible records of individuals who underwent bariatric surgery. Results Within the entire sample, a mere 5.0% (806 individuals) had undertook bariatric surgery, with females comprising 54% of this specific subgroup. The average age within this group was 38.85 years (SD 13.02) and range (18-87). Post-operative results showed that 33% of these individuals remained classified as obese. Utilizing the backward likelihood ratio regression model, it was determined that factors including age, decreased consumption of fresh juices and chicken, as well as current tobacco use, were significantly associated with persistent obesity. Conclusion The findings of this study suggest an association between the non-obese group and healthier lifestyle choices, including the consumption of high-protein diets and fresh juices, alongside a decreased prevalence of smoking. These observations underscore the significance of maintaining a healthy lifestyle for positive weight loss outcomes following bariatric surgery.
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Affiliation(s)
- Nora A. Althumiri
- Informed Decision Making (IDM), Riyadh, Saudi Arabia
- Sharik Association for Research and Studies, Riyadh, Saudi Arabia
| | - Nasser F. Bindhim
- Informed Decision Making (IDM), Riyadh, Saudi Arabia
- Sharik Association for Research and Studies, Riyadh, Saudi Arabia
- College of Medicine, Alafia University, Riyadh, Saudi Arabia
| | | | - Norah AlMousa
- Sharik Association for Research and Studies, Riyadh, Saudi Arabia
| | | | - Arwa Alumran
- Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Li Z, Chen G, Wang L, Wuyun Q, Sang Q, Wang J, Tian C, Shang M, Wang Z, Du D, Zhang N. Analysis of Correlation between Age and Satisfied Total Weight Loss Percentage Outcome at 1 Year after Bariatric Surgery using the Restricted Cubic Spline Function: A Retrospective Study in China. Obes Surg 2023; 33:3133-3140. [PMID: 37624490 DOI: 10.1007/s11695-023-06691-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/12/2023] [Accepted: 06/16/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE This study aims to explore the relationship between age and whether the percentage of total weight loss (TWL%) is ≥ 25% or not at 1 year after bariatric surgery (BS). We aimed to provide evidence for the stratified treatment of spatients with obesity at different ages. METHODS The primary outcome evaluated was whether TWL% was no less than 25% at 1 year after BS. A TWL% ≥ 25% was defined as a satisfied TWL% outcome. Logistic regression analysis and the restricted cubic spline (RCS) function were used to analyze the relationship between age and the satisfied TWL% outcome at 1 year after BS. RESULTS Two hundred and ninety-one patients were included in our study. After adjusting for potential confounders, the odds ratios (ORs) of the corresponding quartiles of age associated with satisfied TWL% outcome were 1.00 (reference), 1.117 [95% confidence interval (95% CI) = 0.540-2.311], 1.378 (95% CI = 0.647-2.935), and 0.406 (95% CI = 0.184-0.895). RCS analysis revealed a non-linear inverted L-shaped association between age and satisfied TWL% outcome at 1 year after BS (non-linear P = 0.033). CONCLUSION Age was an independent predictor of satisfied TWL% outcome one year following BS, and our study considered 32 years as a potential cut-off point. For Chinese patients over the age of 32 who are eligible for BS, it may be beneficial to do BS earlier as the probability of achieving a satisfied TWL% outcome may decrease with age.
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Affiliation(s)
- Zhehong Li
- Surgery Centre of Diabetes Mellitus, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Guanyang Chen
- Department of General Surgery, Peking University Ninth School of Clinical Medicine, Beijing, China
| | - Liang Wang
- Surgery Centre of Diabetes Mellitus, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Qiqige Wuyun
- Surgery Centre of Diabetes Mellitus, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Qing Sang
- Department of General Surgery, Peking University Ninth School of Clinical Medicine, Beijing, China
| | - Jing Wang
- Surgery Centre of Diabetes Mellitus, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Chenxu Tian
- Surgery Centre of Diabetes Mellitus, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Mingyue Shang
- Surgery Centre of Diabetes Mellitus, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Zheng Wang
- Surgery Centre of Diabetes Mellitus, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Dexiao Du
- Surgery Centre of Diabetes Mellitus, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
| | - Nengwei Zhang
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
- Department of General Surgery, Peking University Ninth School of Clinical Medicine, Beijing, China.
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Kan H, Swindle JP, Bae J, Dunn JP, Buysman EK, Gronroos NN, Bengtson L, Chinthammit C, Ford J, Ahmad N. Weight management treatment modalities in patients with overweight or obesity: A retrospective cohort study of administrative claims data. OBESITY PILLARS (ONLINE) 2023; 7:100072. [PMID: 37990675 PMCID: PMC10661997 DOI: 10.1016/j.obpill.2023.100072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 11/23/2023]
Abstract
Background The purpose of this study was to describe demographic and clinical characteristics among patients who have medical encounters for weight management treatments and to investigate the association of those characteristics with treatment modality. Methods This was a retrospective database study using medical claims, pharmacy claims, and enrollment information from commercial and Medicare Advantage with Part D members in the Optum Research Database from 01/01/2011-2/29/2020. Adult patients with a claim for a weight management treatment from 01/01/2012-2/28/2019 were categorized into cohorts according to the highest intensity intervention received. To examine the association between patient characteristics and treatment modality received, a multinomial logit model was performed. Results Cohorts by increasing intensity included lifestyle intervention (LSI, n = 67,679), weight reduction pharmacotherapy (WRRx) with an anti-obesity medication (AOM, n = 6,905), weight reduction procedure (WRP, n = 1,172), and weight reduction surgery (WRS, n = 18,036). Approximately 32.1% and 16.6% of patients who received WRS or WRP had an LSI during the 12-month baseline, and only 0.6% and 0.4% had treatment with long-term AOMs. In a multinomial logit model, patients with type 2 diabetes (not including WRRx cohort), respiratory disorders, cardiovascular risk factors, pain disorders, and mental health conditions had increased odds of treatment with higher intensity intervention versus LSI. Patients who were male, received an intervention more recently (2016-2019), or had a Charlson comorbidity score of 1 (compared to 0) had decreased odds of treatment with higher intensity interventions. Conclusion In this study, age, sex, body mass index, obesity-related complications, and Charlson comorbidity score appeared to influence the type of weight management treatment modality received. This study improves understanding of weight management treatment utilization and identifies gaps and opportunities to improve obesity care with the appropriate use of different treatment modalities.
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Affiliation(s)
- Hong Kan
- Eli Lilly, 893 Delaware St, Indianapolis, IN, USA
| | - Jason P. Swindle
- Evidera, 500 Totten Pond Rd, Waltham, MA, 02451, USA
- Formerly Optum, 11000 Optum Circle, Eden Prairie, MN, USA
| | - Jay Bae
- Eli Lilly, 893 Delaware St, Indianapolis, IN, USA
| | | | | | | | - Lindsay Bengtson
- Boehringer Ingelheim, 900 Ridgebury Rd, Ridgefield, CT, USA
- Formerly Optum, 11000 Optum Circle, Eden Prairie, MN, USA
| | | | - Janet Ford
- Agios Pharmaceuticals, Inc., Cambridge, MA, USA
- Formally Eli Lilly, 893 Delaware St, Indianapolis, IN, USA
| | - Nadia Ahmad
- Eli Lilly, 893 Delaware St, Indianapolis, IN, USA
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Keshavjee SH, Schwenger KJP, Yadav J, Pickel L, Ghorbani Y, Sung HK, Jung H, Lou W, Fischer SE, Jackson TD, Okrainec A, Allard JP. Adipose Tissue and Plasma Markers Associated with HbA1c Pre- and Post-bariatric Surgery: a Cross-sectional and Cohort Study. Obes Surg 2023; 33:2443-2451. [PMID: 37380880 DOI: 10.1007/s11695-023-06679-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE Obesity can be associated with chronic inflammation and dysregulated expression of inflammatory adipokines that contribute to insulin resistance and type 2 diabetes. This may also affect the clinical response to bariatric surgery. Our objective was whether baseline visceral adipose tissue features and plasma adipokine are associated with HbA1c ≥0.06 at the time of Roux-en-Y gastric bypass (RYGB) surgery and with persistently elevated HbA1c at 12 months post-RYGB. METHODS During the surgery, adipose biopsies and plasma were collected for adipokine/cytokine profile. Clinical and biochemical measurements were also collected at the time of RYGB and, in those with baseline elevated HbA1c, at 12 months post-RYGB. RESULTS In the cross-sectional study, 109 patients (82.6% female; age 49 years; BMI 46.98 kg/m2) participated. Of those with elevated HbA1c at baseline (n = 61), 47 patients had repeated measurements at 12 months post-RYGB (23% drop-out). Using a multivariate logistic regression model, older age (adjusted odds ratio (aOR), 1.14; 95% confidence interval (CI), 1.06-1.22) and higher plasma resistin (aOR, 5.30; 95% CI, 1.25-22.44) were associated with higher odds of HbA1c ≥ 0.06, whereas higher plasma adiponectin (aOR, 0.993; 95% CI, 0.99-0.996) was associated with lower odds of HbA1c ≥0.06. In addition, baseline higher average adipose cell area (aOR, 1.0017; 95% CI, 1.0002-1.0032) and plasma resistin (aOR, 1.0004; 95% CI, 1.0000-1.0009) were associated with higher odds of having persistently elevated HbA1c at 12 months post-RYGB. CONCLUSION Our study suggests that baseline plasma adipokine dysregulation, specifically high resistin, and adipocyte hypertrophy may affect the clinical response to RYGB.
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Affiliation(s)
- Sara H Keshavjee
- Division of General Surgery, University Health Network, University of Toronto, 190 Elizabeth Street, 1st Floor, Suite 408, Toronto, ON, M5G 2C4, Canada
| | - Katherine J P Schwenger
- Division of Gastroenterology, Toronto General Hospital, University Health Network, 6 Queen's Park Crescent West, Third Floor, Toronto, ON, M5S 3H2, Canada
| | - Jitender Yadav
- Department of Immunology, University of Toronto, 1 King's College Circle, Medical Sciences Building, Room 7207, Toronto, ON, M5S 1A8, Canada
| | - Lauren Pickel
- Translational Medicine Program, The Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada
| | - Yasaman Ghorbani
- Division of Gastroenterology, Toronto General Hospital, University Health Network, 6 Queen's Park Crescent West, Third Floor, Toronto, ON, M5S 3H2, Canada
| | - Hoon-Ki Sung
- Translational Medicine Program, The Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, 1 King's College Circle, 6th Floor, Toronto, ON, M5S 1A8, Canada
| | - Hyejung Jung
- Dalla Lana Public Health Department, University of Toronto, 155 College St, 6th Fl, Toronto, ON, M5T 3M7, Canada
| | - Wendy Lou
- Dalla Lana Public Health Department, University of Toronto, 155 College St, 6th Fl, Toronto, ON, M5T 3M7, Canada
| | - Sandra E Fischer
- Department of Laboratory Medicine and Pathobiology, University of Toronto, 1 King's College Circle, 6th Floor, Toronto, ON, M5S 1A8, Canada
| | - Timothy D Jackson
- Division of General Surgery, University Health Network, University of Toronto, 190 Elizabeth Street, 1st Floor, Suite 408, Toronto, ON, M5G 2C4, Canada
| | - Allan Okrainec
- Division of General Surgery, University Health Network, University of Toronto, 190 Elizabeth Street, 1st Floor, Suite 408, Toronto, ON, M5G 2C4, Canada
| | - Johane P Allard
- Division of Gastroenterology, Toronto General Hospital, University Health Network, 6 Queen's Park Crescent West, Third Floor, Toronto, ON, M5S 3H2, Canada.
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9
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Sayadishahraki M, Salehi A. The Association of Demographic Characteristics with the Rate of Weight Loss and Changes in Nutritional Factors (Albumin, Vitamin D3, Ferritin) One Year after One Anastomosis Gastric Bypass. Adv Biomed Res 2023; 12:192. [PMID: 37694235 PMCID: PMC10492623 DOI: 10.4103/abr.abr_442_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/09/2023] [Accepted: 03/15/2023] [Indexed: 09/12/2023] Open
Abstract
Background The effect of bariatric surgery on weight loss (WL) of patients with severe obesity is an established finding. However, some studies have shown that other factors such as demographic characteristics can also be involved in the extent of success and relapse of obesity. Thus, this study was performed to determine the association of demographic characteristics with the rate of weight loss and changes in nutritional factors one year after one anastomosis gastric bypass (OAGB). Materials and Methods In this cross-sectional study, 121 patients undergoing OAGB were investigated. Patients' body mass index (BMI), nutritional factors (including levels of albumin, vitamin D3, and serum ferritin), and demographic characteristics were measured one year after the surgery. Results The BMI one year after surgery was significantly lower than before surgery (47.12 ± 5.08 kg/m2 vs. 29.42 ± 3.86 kg/m2; P value <0.001). WL was 37.37 ± 6.70%. In addition, the serum level of vitamin D3 one year after surgery with the mean of 44.54 ± 17.25 was significantly higher than its level before surgery with the mean of 38.13 ± 14.42 (P value <0.001). WL in less than 50 years old and married patients was significantly higher than WL in over 50 years old and single patients (P value <0.05). Moreover, the decrease in serum ferritin level with the mean of 1.90 ± 0.56 ng/ml in women was significantly higher than its decrease with the mean of 3.02 ± 0.94 ng/ml in men (P value = 0.003). Conclusion Some demographic characteristics such as age, gender, and marital status seem to affect the rate of weight loss or ferritin level one year after OAGB.
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Affiliation(s)
- Masoud Sayadishahraki
- Department of General Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Atefe Salehi
- General Physician, Isfahan University of Medical Sciences, Isfahan, Iran
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10
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Barbuti M, Carignani G, Weiss F, Calderone A, Fierabracci P, Salvetti G, Menculini G, Tortorella A, Santini F, Perugi G. Eating disorders and emotional dysregulation are associated with insufficient weight loss after bariatric surgery: a 1-year observational follow-up study. Eat Weight Disord 2023; 28:49. [PMID: 37266717 DOI: 10.1007/s40519-023-01574-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/14/2023] [Indexed: 06/03/2023] Open
Abstract
PURPOSE Subjects with obesity, especially those seeking bariatric surgery, exhibit high rates of mental disorders and marked psychopathological traits. The primary objective of this prospective, non-interventional study was to investigate whether the presence of different psychiatric disorders, attention deficit/hyperactivity disorder (ADHD) symptomatology and emotional dysregulation influenced weight loss at 1-year follow-up after surgery. METHODS Subjects consecutively referred for pre-surgical evaluation at the Obesity Center of Pisa University Hospital were recruited. Psychiatric diagnoses were made through the Mini-International Neuropsychiatric Interview (MINI) and ADHD symptomatology was assessed with the Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS). Emotional dysregulation was investigated through the WRAADDS and self-report questionnaires. After surgery, weight and obesity-related comorbidities were monitored during follow-up. RESULTS Of the 99 participants recruited, 76 underwent surgery and 65 could be reevaluated 1 year after surgery. Subjects with insufficient weight loss (excess body mass index loss ≤ 53%, n = 15) had more frequent lifetime binge eating disorder (BED) and BED-mood disorders comorbidity than subjects with favorable post-surgical outcome. Additionally, they scored higher on both physician-administered and self-report scales assessing emotional dysregulation, which represents a nuclear symptom of ADHD in adults. At the logistic regression analysis, older age, higher preoperative excess body mass index and greater affective instability were predictors of reduced weight loss at 1-year follow-up. CONCLUSION Emotional dysregulation seems to be associated with a worse outcome after bariatric surgery. Further studies with larger samples and longer follow-up are needed to confirm the influence of different psychiatric disorders and psychopathological traits on post-surgical outcome. LEVEL OF EVIDENCE V, prospective descriptive study.
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Affiliation(s)
- Margherita Barbuti
- 2nd Psychiatry Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Giulia Carignani
- 2nd Psychiatry Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Francesco Weiss
- 2nd Psychiatry Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Alba Calderone
- 1st Endocrinology Unit, Department of Clinical and Experimental Medicine, Obesity and Lipodystrophy Research Center, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Paola Fierabracci
- 1st Endocrinology Unit, Department of Clinical and Experimental Medicine, Obesity and Lipodystrophy Research Center, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Guido Salvetti
- 1st Endocrinology Unit, Department of Clinical and Experimental Medicine, Obesity and Lipodystrophy Research Center, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Giulia Menculini
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Piazza Lucio Severi 1, 06132, Perugia, Italy
| | - Alfonso Tortorella
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Piazza Lucio Severi 1, 06132, Perugia, Italy
| | - Ferruccio Santini
- 1st Endocrinology Unit, Department of Clinical and Experimental Medicine, Obesity and Lipodystrophy Research Center, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Giulio Perugi
- 2nd Psychiatry Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Savi 10, 56126, Pisa, Italy.
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11
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Azhri AS, Almuqati A, Azzeh F, Alamro N, Azhar W, Qadhi A, Ghafouri K. Factors influencing body weight one year after bariatric surgery. Medicine (Baltimore) 2023; 102:e33111. [PMID: 36930099 PMCID: PMC10019114 DOI: 10.1097/md.0000000000033111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 02/07/2023] [Indexed: 03/18/2023] Open
Abstract
The significant outcome of bariatric surgery (BS) is weight loss, which may be affected by many factors, such as initial body weight before surgery, sex, and dietary intake. Moreover, rapid weight loss is associated with an increased incidence of postsurgical cholelithiasis. To investigate the observed weight loss outcomes during the first year after BS, we investigated the factors that may influence weight loss and to detect the efficacy of prophylactic ursodeoxycholic acid against gallstone formation. This was a retrospective cohort study of all patients with morbid obesity who underwent BS in the hospital and completed a 1-year follow up. Patients with a previous BS or a history of cholecystectomy before BS were excluded. Data were extracted from the medical records at multiple postoperative intervals. There was significant weight loss in terms of percentage of excess weight loss and reduction in body mass index postoperative. A significant correlation was found between the percent of excess weight loss and age, initial body mass index, and initial weight, but there was no significant correlation with sex or type of surgery. The incidence of postoperative cholecystectomy is almost negligible. A significant association was found between age and weight loss after BS. ursodeoxycholic acid is an effective prophylaxis to decrease the incidence of cholecystectomy after BS.
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Affiliation(s)
- Afnan Sameer Azhri
- Department of Clinical Nutrition, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Asma Almuqati
- Department of Clinical Nutrition, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Firas Azzeh
- Department of Clinical Nutrition, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Nuha Alamro
- Department of Clinical Nutrition, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Wedad Azhar
- Department of Clinical Nutrition, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Alaa Qadhi
- Department of Clinical Nutrition, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Khloud Ghafouri
- Department of Clinical Nutrition, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
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12
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Crozet J, Pasquer A, Pelascini E, Robert M. Factors influencing bariatric surgery outcomes. J Visc Surg 2023; 160:S7-S11. [PMID: 36922261 DOI: 10.1016/j.jviscsurg.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
The outcomes of bariatric surgery, while often impressive, are not universally satisfactory; they vary from patient to patient and from operation to operation. Between 20-30% of patients experience suboptimal weight loss or substantial weight regain early in their postoperative course. Confronted with this chronic disease, and given that failures are difficult to manage, it is essential to better characterize obesity preoperatively, considering other metrics beyond just the body mass index (BMI), to select the best candidates for surgery and optimize the benefit/risk ratio. Based on the data of the most recent studies on bariatric surgery, our objective is to identify the predictive factors of weight loss as well as the risk factors of failure. Our analysis indicates that the choice of the surgical technique, age, initial BMI, ethnic origin, the presence of eating disorders and metabolic factors all have an impact on weight-loss outcomes after bariatric surgery. Thus, it is of major importance to carefully select patients during a preoperative multidisciplinary discussion in order to optimize weight loss and metabolic outcomes.
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Affiliation(s)
- J Crozet
- Department of digestive surgery, center of bariatric surgery, university hospital of Édouard-Herriot, hospices civils de Lyon, Lyon, France; Specialized center of obesity, university hospital of Lyon, hospices civils de Lyon, Pierre-Bénite, France; University Claude Bernard Lyon 1, Lyon, France.
| | - A Pasquer
- Department of digestive surgery, center of bariatric surgery, university hospital of Édouard-Herriot, hospices civils de Lyon, Lyon, France; Specialized center of obesity, university hospital of Lyon, hospices civils de Lyon, Pierre-Bénite, France; University Claude Bernard Lyon 1, Lyon, France
| | - E Pelascini
- Department of digestive surgery, center of bariatric surgery, university hospital of Édouard-Herriot, hospices civils de Lyon, Lyon, France; Specialized center of obesity, university hospital of Lyon, hospices civils de Lyon, Pierre-Bénite, France; University Claude Bernard Lyon 1, Lyon, France
| | - M Robert
- Department of digestive surgery, center of bariatric surgery, university hospital of Édouard-Herriot, hospices civils de Lyon, Lyon, France; Specialized center of obesity, university hospital of Lyon, hospices civils de Lyon, Pierre-Bénite, France; University Claude Bernard Lyon 1, Lyon, France; Carmen lab, Inserm unit 1060, France
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13
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Bravo-De Ávila P, Díaz-Roesh M, Gutierrez-Acosta K, Romero RJ. Preoperative Quality of Life Predicting Weight Loss After Laparoscopic Sleeve Gastrectomy. Bariatr Surg Pract Patient Care 2023. [DOI: 10.1089/bari.2022.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Affiliation(s)
| | | | | | - Rey Jesús Romero
- Department of Bariatric and Metabolic Surgery, Obesity Health, Boca del Río, México
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14
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Pfefferkorn U, Hort S, Beluli M, La Vista M, Züger T. Weight Loss After Bariatric Surgery in Different Age Groups. Obes Surg 2023; 33:1154-1159. [PMID: 36757647 DOI: 10.1007/s11695-023-06488-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/25/2023] [Accepted: 01/30/2023] [Indexed: 02/10/2023]
Abstract
PURPOSE Weight loss after bariatric operations may be reduced in older patients due to changes in metabolism. Some studies showed inferior weight loss in older patients compared to younger ones while others showed no such difference. In order to counsel patients about the expected weight loss after bariatric surgery, recommendations stratified by age are important. METHODS This study encompasses a retrospective analysis of 500 consecutive patients with RYGB or sleeve gastrectomies from a single institution with a mean follow-up time of 3.6 years. Patients were stratified into five groups according to age at the time point of the operation: < 30 years, 30-39 years, 40-49 years, 50-59 years, and ≥ 60 years. RESULTS Weight loss expressed in percent excessive body mass index loss (%EBMIL) at nadir were 86.6, 89.5, 84.0, 77.9, and 76.4% and 75.6, 78.4, 73.3, 68.0, and 69.0% at the time of last follow-up for the five groups, respectively. Weight loss was significantly higher in younger patients than in older patients for both time points. The total number of comorbidities that showed complete remission (normal values without treatment), was also significantly higher in the younger age groups. CONCLUSIONS Primary bariatric operations yield better weight loss results and remission rates of obesity related comorbidities in younger patients, but are still effective in older individuals.
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Affiliation(s)
- Urs Pfefferkorn
- Department of Surgery, Kantonsspital Olten, Baslerstrasse 150, 4600, Olten, Switzerland.
| | - Sabrina Hort
- Department of Surgery, Kantonsspital Baden, 5404, Baden, Switzerland
| | - Melika Beluli
- Department of Surgery, Kantonsspital Olten, Baslerstrasse 150, 4600, Olten, Switzerland
| | - Monica La Vista
- Department of Endocrinology, Diabetes and Metabolic Diseases, Kantonsspital Olten, 4600, Olten, Switzerland
| | - Thomas Züger
- Department of Endocrinology, Diabetes and Metabolic Diseases, Kantonsspital Olten, 4600, Olten, Switzerland
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15
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Sleeve Gastrectomy: Does the Amount of Stomach Removed Matter? Obes Surg 2023; 33:469-474. [PMID: 36474099 DOI: 10.1007/s11695-022-06383-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 11/17/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Data regarding the associations between percent weight loss and the volume and weight of stomach resected during sleeve gastrectomy (SG) are mixed. The purpose of this study was to evaluate the effect of the size and volume of stomach removed during laparoscopic SG on percent total body weight lost (%TBWL). METHODS An observational case series study was performed on 67 patients for 1 year after SG at a single university-affiliated, tertiary care hospital. Data were collected on demographics, medical history, and %TBWL at 3, 6, and 12 months post-operatively. Pearson's correlation matrices and multiple linear regression analyses were performed. RESULTS Most patients (88.1%) were female with a mean age of 44 years. The mean volume of stomach resected was 1047.0 cubic centimeters, and the median weight resected was 123.0 g. Follow-up data were available for 44 patients at 1-year post-operation. There was no association between the volume and weight of stomach resected and %TBWL at 1-year post-operation; however, greater %TBWL was associated with younger patient age (r = - 0.525, p < 0.001). CONCLUSION One year after SG, no associations between %TBWL and the volume and weight of stomach resected were observed.
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16
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Quintero JHR, Grosser R, Velez GR, Ramos-Santillan VO, Pereira X, Flores FM, Choi J, Moran-Atkin E, Camacho D, Lima DL. Safety and efficacy of roux-en-y gastric bypass in older aged patients. Rev Col Bras Cir 2022; 49:e20223332. [PMID: 36197347 PMCID: PMC10578815 DOI: 10.1590/0100-6991e-20223332-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/04/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION laparoscopic Roux-en-Y Gastric Bypass (LRYGB) has been a revolutionary intervention for weight loss with reduction of up to 60-70% of excess body weight. However, these outcomes are not as well validated at the extremes of age, where the safety of the intervention still has some caveats. The aim of this study is to assess the efficacy and safety of primary LRYGB among different age groups. METHODS the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database was queried for patients who underwent primary LRYGB from January 2014 to December 2017 at a single institution. Four groups were created and compared by dividing our sample by age quartiles. The primary outcome was percent excess weight loss (%EWL) at 1 year. Additional operative outcomes and complications were also compared across groups. RESULTS a total of 1013 patients underwent non-revisional LRYGB during the study period. Mean %EWL at one year was 55%. When compared between quartiles, there was a statistically significant difference in %EWL: 1st 62%, 2nd 57%, 3rd 54% and 4th 47% (p=0.010). The differences in the secondary outcomes between age groups did not demonstrate statistical significance. CONCLUSIONS though patients in the fourth age quartile (range) did not demonstrate a statistically significant increase in adverse outcomes, they did lose less weight compared to other cohorts. The %EWL at one year after RYGB varied by age in our cohort. Goals after bariatric surgery should be individualized as weight loss is less robust with aging.
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Affiliation(s)
| | - Rachel Grosser
- - Montefiore Medical Center, Surgery - The Bronx - New York - Estados Unidos
| | | | | | - Xavier Pereira
- - Montefiore Medical Center, Surgery - The Bronx - New York - Estados Unidos
| | | | - Jenny Choi
- - Montefiore Medical Center, Surgery - The Bronx - New York - Estados Unidos
| | - Erin Moran-Atkin
- - Montefiore Medical Center, Surgery - The Bronx - New York - Estados Unidos
| | - Diego Camacho
- - Montefiore Medical Center, Surgery - The Bronx - New York - Estados Unidos
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17
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Effects of Antibiotics on Weight in Obese Patients after Sleeve Gastrectomy. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:1592786. [PMID: 36193079 PMCID: PMC9526625 DOI: 10.1155/2022/1592786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/29/2022] [Accepted: 09/08/2022] [Indexed: 11/17/2022]
Abstract
Obese patients can significantly reduce weight and have a positive impact on obesity-related diseases. However, the risk of infection complications in obese people is higher than that in normal people, especially the surgical site infection. This research investigates the effect of antibiotics on weight change of obese patients after laparoscopic sleeve gastrectomy (LSG). A retrospective analysis was performed on 131 morbidly obese patients or obese patients with complications who received LSG treatment in the Third Hospital of Shanxi Medical University from 2013 to 2020. Patients were separated into the antibiotic group (59 cases) and the normal group (72 cases) according to whether antibiotics were used after surgery. The differences of postoperative weight-related indexes, inflammation-related indexes, and short-term complications were compared between the two groups. At 12-month follow-up, the % excess weight loss (%EWL) in the antibiotic group was statistically abated than that in the normal group (92.99 ± 28.60, P < 0.01). In addition, the percentage of total weight loss (%total weight loss (%TWL)) was abated in the antibiotic group than in the normal group, but it was not significant (P > 0.05). White blood cell count and neutrophil count in the antibiotic group were statistically raised than those in the in normal group (P < 0.05), but neutrophil/lymphocyte ratio (NLR) showed no significant difference. Comparison of short-term postoperative complications between the two groups showed that the number of abdominal wall wound infection, body temperature > 38°C, and abdominal pain > 3 days in the antibiotic group were abated, but they were not statistically significant (P > 0.05). Short-term antibiotic exposure after sleeve gastrectomy had an adverse effect on postoperative weight loss, with no significant improvement in short-term complications.
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18
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Pereira AF, Santa-Cruz F, Coutinho LR, Vieira-DE-Melo MCPT, Hinrichsen EA, Siqueira LT, Figueiredo JL, Ferraz ÁAB. Impact of bariatric surgery in elderly patients with obesity. Rev Col Bras Cir 2022; 49:e20223299. [PMID: 35858036 PMCID: PMC10578788 DOI: 10.1590/0100-6991e-20223299-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/30/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION to evaluate the long-term impact of bariatric surgery in the elderly population. METHODS a retrospective study including all patients older than 60 years who underwent Roux-en-Y gastric bypass (RYGB) at our center and maintained a follow-up longer than 1 year. Clinical and laboratory variables were studied to assess remission of obesity and its comorbidities, as well as variables directly related to the surgical procedure itself, including early and late complications. RESULTS fifty-six patients were studied, mostly female (76,8%), with a mean age of 64.02 ± 3.34. A rate of complications of 37,5% was observed, with 10,7% requiring hospital admission and emergency surgery. The mean excess weight loss (%EWL) was 74.22% ± 26.76. The remission rates of hypertension and diabetes mellitus were 26.08% and 54.54%, respectively. There was significant difference in BMI reduction (12.25 ± 5.42, p<0.001), total cholesterol (31.37 ± 38.89 p<0,001), LDL cholesterol (23.45 ± 34.9, p=0.002), HDL cholesterol (5.14 ± 11.13, p=0,024), triglycerides (48.85 ± 56.15 p<0.001), HbA1C (1,81 ± 1,97, p<0,001) e PCR (1.43 ± 1.96, p<0.001). CONCLUSION bariatric surgery was effective in weight loss and remission of comorbidities in the elderly obese population within the long term.
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Affiliation(s)
- Adriano F Pereira
- - Universidade Federal de Pernambuco, Pós-Graduação em Cirurgia - Recife - PE - Brasil
| | - Fernando Santa-Cruz
- - Universidade Federal de Pernambuco, Pós-Graduação em Cirurgia - Recife - PE - Brasil
| | - Lucas R Coutinho
- - Universidade Federal de Pernambuco, Curso de Medicina - Recife - PE - Brasil
| | | | - Eduarda A Hinrichsen
- - Hospital Getúlio Vargas, Programa de Residência Médica em Cirurgia Geral - Recife - PE - Brasil
| | - Luciana T Siqueira
- - Universidade Federal de Pernambuco, Departamento de Cirurgia - Recife - PE - Brasil
| | - José-Luiz Figueiredo
- - Universidade Federal de Pernambuco, Departamento de Cirurgia - Recife - PE - Brasil
| | - Álvaro A B Ferraz
- - Universidade Federal de Pernambuco, Departamento de Cirurgia - Recife - PE - Brasil
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19
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Sleeve Gastrectomy in Septuagenarians: a Case-Control Study. Obes Surg 2022; 32:2846-2852. [PMID: 35788952 DOI: 10.1007/s11695-022-06193-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 06/26/2022] [Accepted: 06/27/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE There are few studies published referring to bariatric surgery in patients older than 70 years. The aim of this study is to evaluate whether there are benefits to performing sleeve gastrectomy (SG) in patients over 70 years of age and to compare the results with a younger control group. MATERIALS AND METHODS Data were retrospectively collected from a Private Clinic's electronic medical records of patients undergoing SG between June 2017 and September 2020. Inclusion criteria were patients older than 70 years [septuagenarian group (SpG)] who met all institutional protocols. Patients in the control group (CG) were selected with a 1:1 ratio and under 60 years of age, according to body mass index and comorbidities. The primary endpoint of the study was to evaluate the morbidity and mortality during the 30-day postoperative period and percentage of total weight loss (%TWL), and improvement of comorbidities after 1 year of follow-up. RESULTS Fifty patients were included in the study. Both groups were similar regarding gender, weight, BMI, and presence of DM. The 30-day morbidity and mortality were similar between the groups. The patients in the SpG had 26.9% of %TWL and the CG, 28% (p = 0.32). The remission rate of DM (50% vs. 85% p = 0.01) and SAH (30% vs. 64% p = 0.04) was lower for septuagenarian patients. CONCLUSION The sleeve gastrectomy surgery performed in patients over 70 years of age is safe. The early results suggest similar benefits regarding weight loss and improvement of comorbidities to those having SG before age 60.
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Voglino C, Badalucco S, Tirone A, Ciuoli C, Cantara S, Benenati N, Bufano A, Formichi C, Croce F, Gaggelli I, Vuolo ML, Vuolo G. Follow-up after bariatric surgery: is it time to tailor it? Analysis of early predictive factors of 3-year weight loss predictors of unsuccess in bariatric patients. Updates Surg 2022; 74:1389-1398. [PMID: 35780262 PMCID: PMC9338161 DOI: 10.1007/s13304-022-01314-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 06/14/2022] [Indexed: 12/03/2022]
Abstract
Bariatric surgery (BS) is the most effective treatment strategy for obesity. Nevertheless, a subset of patients does not reach a successful weight loss or experience long-term weight regain. Conflicting evidence exists regarding predictors of BS outcomes. We aimed to define the early factors linked to 3 year unsuccessful weight loss in order to promote a tailored close follow-up. We enrolled 443 patients who underwent BS from January 2014 to December 2018 with a 3 year follow-up. An unsuccessful BS outcome was defined as a percentage of total weight loss (%TWL) < 20. We compared the characteristics between successful and unsuccessful patients in order to identify predictor factors of unsuccess after surgery. We found that the proportion of patients with unsuccessful weight loss progressively increased from one to three years after BS. In a multiple regression model, only 1 month %TWL and sleeve gastrectomy (SG) were significantly associated with 3 year unsuccessful weight loss. We stratified our cohort in four groups according to the risk of BS unsuccess, in terms of 1 month %TWL and type of surgery (SG vs gastric bypass). Interestingly, groups showed a significant difference in terms of %TWL at each follow-up point. Patients submitted to SG with lower 1 month %TWL must be considered at higher risk of future weight regain; consequently, they require a tailored and closer follow-up.
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Affiliation(s)
- Costantino Voglino
- Department of General and Specialized Surgery, Unit of Bariatric Surgery, University of Siena, Policlinico "Le Scotte", Viale Bracci 14, 53100, Siena, Italy
| | - Simona Badalucco
- Department of General and Specialized Surgery, Unit of Bariatric Surgery, University of Siena, Policlinico "Le Scotte", Viale Bracci 14, 53100, Siena, Italy.
| | - Andrea Tirone
- Department of General and Specialized Surgery, Unit of Bariatric Surgery, University of Siena, Policlinico "Le Scotte", Viale Bracci 14, 53100, Siena, Italy
| | - Cristina Ciuoli
- Department of Medicine, Surgery and Neurosciences, Unit of Endocrinology, University of Siena, Viale Bracci, Policlinico "Le Scotte", 53100, Siena, Italy
| | - Silvia Cantara
- Department of Medicine, Surgery and Neurosciences, University of Siena, Viale Bracci, Policlinico "Le Scotte", 53100, Siena, Italy
| | - Nicoletta Benenati
- Department of Medicine, Surgery and Neurosciences, Unit of Endocrinology, University of Siena, Viale Bracci, Policlinico "Le Scotte", 53100, Siena, Italy
| | - Annalisa Bufano
- Department of Medicine, Surgery and Neurosciences, Unit of Endocrinology, University of Siena, Viale Bracci, Policlinico "Le Scotte", 53100, Siena, Italy
| | - Caterina Formichi
- Department of Medicine, Surgery and Neurosciences, Unit of Endocrinology, University of Siena, Viale Bracci, Policlinico "Le Scotte", 53100, Siena, Italy
| | - Federica Croce
- Department of Diagnostic Imaging, Hospital Campostaggia, Campostaggia, 53036, Poggibonsi, SI, Italy
| | - Ilaria Gaggelli
- Department of General and Specialized Surgery, Unit of Bariatric Surgery, University of Siena, Policlinico "Le Scotte", Viale Bracci 14, 53100, Siena, Italy
| | - Maria Laura Vuolo
- Department of General and Specialized Surgery, Unit of Bariatric Surgery, University of Siena, Policlinico "Le Scotte", Viale Bracci 14, 53100, Siena, Italy
| | - Giuseppe Vuolo
- Department of General and Specialized Surgery, Unit of Bariatric Surgery, University of Siena, Policlinico "Le Scotte", Viale Bracci 14, 53100, Siena, Italy
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Emiliano AB, Lopatinsky NR, Kraljević M, Higuchi S, He Y, Haeusler RA, Schwartz GJ. Sex-specific differences in metabolic outcomes after sleeve gastrectomy and intermittent fasting in obese middle-aged mice. Am J Physiol Endocrinol Metab 2022; 323:E107-E121. [PMID: 35658544 PMCID: PMC9273270 DOI: 10.1152/ajpendo.00017.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 01/21/2023]
Abstract
Despite the high prevalence of obesity among middle-aged subjects, it is unclear if sex differences in middle age affect the metabolic outcomes of obesity therapies. Accordingly, in this study, middle-aged obese female and male mice were randomized to one of three groups: sleeve gastrectomy (SG), sham surgery ad libitum (SH-AL), or sham surgery with weight matching to SG through intermittent fasting with calorie restriction (SH-IF). Comprehensive measures of energy and glucose homeostasis, including energy intake, body weight, energy expenditure, glucose and insulin tolerance, and interscapular brown adipose tissue (iBAT) sympathetic innervation density were obtained. At the end of 8 wk, SG and SH-IF females had better metabolic outcomes than their male counterparts. SG females had improved weight loss maintenance, preservation of fat-free mass (FFM), higher total energy expenditure (TEE), normal locomotor activity, and reduced plasma insulin and white adipose tissue (WAT) inflammatory markers. SH-IF females also had lower plasma insulin and WAT inflammatory markers, and higher TEE than SH-IF males, despite their lower FFM. In addition, SH-IF females had higher iBAT sympathetic nerve density than SG and SH-AL females, whereas there were no differences among males. Notably, SH-IF mice of both sexes had the most improved glucose tolerance, highlighting the benefits of fasting, irrespective of weight loss. Results from this study demonstrate that in middle-aged obese mice, female sex is associated with better metabolic outcomes after SG or IF with calorie restriction. Clinical studies are needed to determine if sex differences should guide the choice of obesity therapies.NEW & NOTEWORTHY SG or IF with calorie restriction produces better metabolic outcomes in females than in males. IF with calorie restriction prevents metabolic adaptation, even in the face of fat-free mass loss. IF with calorie restriction in females only, is associated with increased iBAT sympathetic innervation, which possibly mitigates reductions in energy expenditure secondary to fat-free mass loss. Lastly, IF leads to better glucose homeostasis than SG, irrespective of sex.
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Affiliation(s)
| | | | - Marko Kraljević
- Columbia University Medical Center, New York, New York
- Clarunis University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland
| | - Sei Higuchi
- Columbia University Medical Center, New York, New York
| | - Ying He
- Columbia University Medical Center, New York, New York
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Can We Benefit from the Preoperative Psychometric Test with Symptom Checklist-90-Revised (SCL-90-R) to Predict Weight Loss After Sleeve Gastrectomy? Obes Surg 2022; 32:1531-1538. [PMID: 35146601 DOI: 10.1007/s11695-022-05951-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 01/30/2022] [Accepted: 02/03/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND The psychological assessment is crucial before bariatric surgery. Derogatis' Symptom Checklist-90-Revised (SCL-90-R) is one of the most widely used measures of psychological symptoms and distress in both clinical and research settings. We aimed to investigate the predictive value of SCL-90-R subscale scores on postoperative excess weight loss percentage (EWLP) after laparoscopic sleeve gastrectomy (LSG). METHODS Patients who underwent primary LSG for morbid obesity and fully completed preoperative SCL-90-R between January 2016 and July 2019 were retrospectively examined. A multiple linear regression analysis was performed to investigate the relationship between descriptive and psychological variables associated with EWLP percentage at the 12th-month. RESULTS One hundred six patients who met the inclusion criteria were analyzed. The adequate weight loss (EWLP ˃ 50%) was achieved in 90% of patients after 12 months. The multiple linear regression analysis indicated that younger patients (β = - 0.695; 95% CI - 1.056, - 0.333; p < 0.001), and patients with preoperative lower BMI (β = - 1.524; 95% CI - 1.974, - 1.075; p < 0.001) achieved higher EWLP at 12th-month. High somatization score (β = 11.975; 95% CI 3.653, 20.296; p = 0.005) and a low Global Severity Index (GSI) score (β = - 24.276; 95% CI - 41.457, - 7.095; p = 0.006) had a positive effect on EWLP at 12th-month. CONCLUSIONS Preoperative psychological testing can help predict surgical outcomes in the bariatric population. More intense lifestyle and behavioral support can be applied by targeting patients who are expected to lose less weight after surgery, and patients' weight loss potential can be increased.
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Alceste D, Serra M, Raguz I, Gero D, Thalheimer A, Widmer J, File B, Ismaeil A, Steinert RE, Spector AC, Bueter M. Association between microstructure of ingestive behavior and body weight loss in patients one year after Roux-en-Y gastric bypass. Physiol Behav 2022; 248:113728. [DOI: 10.1016/j.physbeh.2022.113728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 01/22/2023]
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QUINTERO JORGEHUMBERTORODRIGUEZ, GROSSER RACHEL, VELEZ GUSTAVOROMERO, RAMOS-SANTILLAN VICENTEOMAR, PEREIRA XAVIER, FLORES FERNANDOMUÑOZ, CHOI JENNY, MORAN-ATKIN ERIN, CAMACHO DIEGO, LIMA DIEGOLAURENTINO. Segurança e eficácia do bypas gástrico em Y de Roux em pacientes idosos. Rev Col Bras Cir 2022. [DOI: 10.1590/0100-6991e-20223332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Introdução: o Bypass Gástrico Laparoscópico em Y de Roux (LRYGB) tem sido uma intervenção revolucionária para perda de peso com redução de até 60-70% do excesso de peso corporal. No entanto, esses resultados não são tão bem validados nos extremos de idade, onde a segurança da intervenção ainda possui algumas ressalvas. O objetivo deste estudo é avaliar a eficácia e segurança do LRYGB entre diferentes faixas etárias. Métodos: O banco de dados do Programa de Acreditação e Melhoria da Qualidade da Cirurgia Metabólica e Bariátrica (MBSAQIP) foi consultado para pacientes submetidos a LRYGB de janeiro de 2014 a dezembro de 2017 em uma única instituição. Quatro grupos foram criados e comparados dividindo a amostra por quartis de idade. O desfecho primário foi perda percentual de excesso de peso (%EWL) em 1 ano. Resultados: 1013 pacientes foram submetidos a LRYGB durante o período do estudo. A média de %EWL em um ano foi de 55%. Quando comparados entre os quartis, houve diferença significante no %EWL: 1º 62%, 2º 57%, 3º 54%, e 4º 47% (p=0,010). As diferenças nos desfechos secundários entre as faixas etárias não demonstraram significância estatística. Conclusões: embora os pacientes no quarto quartil de idade não tenham demonstrado um aumento estatisticamente significativo nos resultados adversos, eles perderam menos peso em comparação com outras coortes. O %EWL um ano após RYGB variou de acordo com a idade em nossa coorte. Os objetivos após a cirurgia bariátrica devem ser individualizados, pois a perda de peso é menos robusta com o envelhecimento.
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Affiliation(s)
| | | | | | | | | | | | - JENNY CHOI
- Montefiore Medical Center, Estados Unidos
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PEREIRA ADRIANOF, SANTA-CRUZ FERNANDO, COUTINHO LUCASR, VIEIRA-DE-MELO MARIACLARAPT, HINRICHSEN EDUARDAA, SIQUEIRA LUCIANAT, FIGUEIREDO JOSÉLUIZ, FERRAZ ÁLVAROAB. Impacto da cirurgia bariátrica em pacientes idosos portadores de obesidade. Rev Col Bras Cir 2022. [DOI: 10.1590/0100-6991e-20223299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Introdução: avaliar o impacto da cirurgia bariátrica na população idosa no longo prazo. Métodos: estudo retrospectivo que incluiu todos os pacientes com mais de 60 anos submetidos ao Bypass gástrico em Y de Roux (BGYR) em nosso centro e que mantiveram seguimento superior a 1 ano. Foram estudadas variáveis clínicas e laboratoriais para avaliação da remissão da obesidade e suas comorbidades, além de variáveis diretamente relacionados ao procedimento cirúrgico em si, incluindo complicações precoces e tardias. Resultados: foram estudados 56 pacientes, a maioria do sexo feminino (76,8%), com idade média de 64,02 ± 3,34. Foi observada uma taxa de complicações de 37,5%, com 10,7% requerendo internamento hospitalar e cirurgia de urgência. A média geral da perda do excesso de peso (%PEP) foi de 74,22% ± 26,76. As taxas de remissão de hipertensão e diabetes mellitus foram de 26,08% e 54,54%, respectivamente. Houve variação significativa no IMC (12,25 ± 5,42, p<0,001), colesterol total (31,37 ± 38,89 p<0,001), colesterol LDL (23,45 ± 34,9, p=0,002), colesterol HDL (5,14 ± 11,13, p=0,024), triglicerídeos (48,85 ± 56,15 p<0,001), HbA1C (1,81 ± 1,97, p<0,001) e PCR (1,43 ± 1,96, p<0,001). Conclusão: a cirurgia bariátrica se mostrou eficaz na perda de peso e na remissão de comorbidades na população de idosos com obesidade no longo prazo..
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Guggino J, Tamisier R, Betry C, Coumes S, Arvieux C, Wion N, Reche F, Pépin JL, Borel AL. Bariatric surgery short-term outcomes in patients with obstructive sleep apnoea: the Severe Obesity Outcome Network prospective cohort. Int J Obes (Lond) 2021; 45:2388-2395. [PMID: 34453099 DOI: 10.1038/s41366-021-00903-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 05/11/2021] [Accepted: 05/27/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND/OBJECTIVES Although the benefits of bariatric surgery have been clearly established, it is not known whether they are as important in patients with obstructive sleep apnoea (OSA). Primary aim: to evaluate whether patients with moderate-to-severe OSA (apnoea-hypopnea index (AHI) ≥ 15 events/h) treated by continuous positive airway pressure/non-invasive ventilation (median [IQR] adherence 6.5 h/night [5; 7.9] at baseline) lose the same amount of body weight 1 year after bariatric surgery as patients with no or mild OSA. Secondary objectives: to compare the evolution of type 2 diabetes and hypertension after bariatric surgery, and surgical complication rates between groups. METHODS/SUBJECTS Analyses were performed in 371 patients included in a prospective cohort of bariatric surgery, the Severe Obesity Outcome Network cohort. Subjects having moderate-to-severe OSA (n = 210) at baseline were compared with other subjects (n = 161). RESULTS Excess weight loss (%EWL) at 1 year was lower in patients with moderate-to-severe OSA than in patients without (64.9%EWL [46.9; 79.5] vs. 73.8%EWL [56.6; 89.3], p < 0.01). Multivariable analysis showed that age, initial body mass index and type of surgery, but not OSA status, were associated with 1-year %EWL. Diabetes remitted in 25 (41%) patients with moderate-to-severe OSA and 16 (48%) patients with no or mild OSA (p = 0.48). Hypertension remitted in 28 (32.9%) patients with moderate-to-severe OSA and 9 (40.9%) with no or mild (p = 0.48). Complication rates were 28 (13.3%) in patients with moderate-to-severe OSA and 12 (7.5%) in patients with no or mild OSA (p = 0.07). CONCLUSIONS Patients with OSA lose less body weight after bariatric surgery. This was related to older age and a higher baseline body mass index. However, the improvements of diabetes and hypertension were similar to that of patients without OSA, and the risk of surgical complications was not higher.
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Affiliation(s)
- Jessica Guggino
- Department of Endocrinology Diabetology Nutrition, Grenoble Alpes University Hospital, Centre Spécialisé de l'Obésité Grenoble Arc Alpin, Grenoble, France
| | - Renaud Tamisier
- Univ. Grenoble Alpes, Inserm, U1300, "Hypoxia-physiopathology" Laboratory, Grenoble Alpes University Hospital, "Pôle Thorax et Vaisseaux", Grenoble, France
| | - Cécile Betry
- Univ. Grenoble Alpes, "Translational Innovation in Medicine and Complexity" (TIMC) Laboratory, Department of Endocrinology Diabetology Nutrition, Grenoble Alpes University Hospital, Grenoble, France
| | - Sandrine Coumes
- Department of Endocrinology Diabetology Nutrition, Grenoble Alpes University Hospital, Centre Spécialisé de l'Obésité Grenoble Arc Alpin, Grenoble, France
| | - Catherine Arvieux
- Univ. Grenoble Alpes, Department of Digestive Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Nelly Wion
- Department of Endocrinology Diabetology Nutrition, Grenoble Alpes University Hospital, Centre Spécialisé de l'Obésité Grenoble Arc Alpin, Grenoble, France
| | - Fabian Reche
- Univ. Grenoble Alpes, "Translational Innovation in Medicine and Complexity" (TIMC) Laboratory, Department of Digestive Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Louis Pépin
- Univ. Grenoble Alpes, Inserm, U1300, "Hypoxia-physiopathology" Laboratory, Grenoble Alpes University Hospital, "Pôle Thorax et Vaisseaux", Grenoble, France
| | - Anne-Laure Borel
- Univ. Grenoble Alpes, Inserm, U1300, "Hypoxia-physiopathology" Laboratory, Department of Endocrinology Diabetology Nutrition, Grenoble Alpes University Hospital, Centre Spécialisé de l'Obésité Grenoble Arc Alpin, Grenoble, France.
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Peña E, León-Mengíbar J, Powell TR, Caixàs A, Cardoner N, Rosa A. Telomere length in patients with obesity submitted to bariatric surgery: A systematic review. EUROPEAN EATING DISORDERS REVIEW 2021; 29:842-853. [PMID: 34545641 DOI: 10.1002/erv.2865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Patients with obesity show evidence of increased levels of inflammation, oxidative stress and premature ageing. Telomere length (TL) is a key marker of cellular ageing, and patients with obesity often present shorter TL. Bariatric surgery (BS) is currently the most effective treatment for severe obesity. The aim of this systematic review was to explore whether the beneficial health effects observed after surgery in obese patients correspond to a restoration in TL or slower rates of shortening. As a secondary aim, we evaluated, at baseline and post-surgery, the relationship between TL and different factors that could play a role in TL changes along time. METHODS Searches for relevant articles were performed in MEDLINE, Web of Knowledge and SCOPUS. Prospective longitudinal studies that evaluated leukocyte TL in adult patients who had undergone BS were included. Data were extracted and evaluated by two independent researchers. The protocol was registered in PROSPERO with the number CRD42020197711. RESULTS Seven studies based on independent samples that fulfilled our inclusion criteria were included. Obese patients showed shorter telomeres compared to healthy individuals. Long-term studies (>2 years) seem to suggest an improvement in TL after surgery presumably due to the improvement of the inflammatory and oxidative levels of the patients induced by weight loss. CONCLUSION Studies seem to point towards a beneficial long-term effect of BS on TL recovery. However, the scarce number of studies and the heterogeneity in the variables analysed in the different cohorts make it difficult to draw a firm conclusion. More studies are needed to evaluate long-term changes to TL following BS.
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Affiliation(s)
- Eleonora Peña
- Secció de Zoologia i Antropologia Biològica, Departament de Biologia Evolutiva, Ecologia i Ciències Ambientals, Facultat de Biologia, Universitat de Barcelona (UB), Barcelona, Spain.,Institut de Biomedicina, Universitat de Barcelona (UB), Barcelona, Spain
| | - Josep León-Mengíbar
- Institut d'Investigació i Innovació Parc Taulí (I3PT), Corporacio Sanitària Parc taulí, Sabadell, Spain.,Endocrinology and Nutrition Department, Hospital Universitari Parc Tauli, Sabadell, Spain.,Medicine Department, Universitat Autònoma de Barcelona (UAB), Sabadell, Spain
| | - Timothy R Powell
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Division of Infectious Diseases, Weill Cornell Medicine, Cornell University, New York, New York, USA
| | - Assumpta Caixàs
- Institut d'Investigació i Innovació Parc Taulí (I3PT), Corporacio Sanitària Parc taulí, Sabadell, Spain.,Endocrinology and Nutrition Department, Hospital Universitari Parc Tauli, Sabadell, Spain
| | - Narcís Cardoner
- Institut d'Investigació i Innovació Parc Taulí (I3PT), Corporacio Sanitària Parc taulí, Sabadell, Spain.,Mental Health Department, Corporació Sanitària Parc Taulí Sabadell, Barcelona, Spain.,Depression and Anxiety Program, Department of Mental Health, Parc Tauli Sabadell, Hospital Universitari, Barcelona, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centre for Biomedical Network on Mental Health (CIBERSAM), Instituto Salud Carlos III, Barcelona, Spain
| | - Araceli Rosa
- Secció de Zoologia i Antropologia Biològica, Departament de Biologia Evolutiva, Ecologia i Ciències Ambientals, Facultat de Biologia, Universitat de Barcelona (UB), Barcelona, Spain.,Institut de Biomedicina, Universitat de Barcelona (UB), Barcelona, Spain.,Centre for Biomedical Network on Mental Health (CIBERSAM), Instituto Salud Carlos III, Barcelona, Spain
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Serin SO, Sisik A, Basak F. Relationship between monocyte-to-high-density lipoprotein cholesterol ratio and excess weight loss in laparoscopic sleeve gastrectomy. Biomark Med 2021; 15:1367-1375. [PMID: 34514845 DOI: 10.2217/bmm-2021-0244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: The present study evaluates the relationship between the monocyte-to-high-density lipoprotein cholesterol ratio (MHR) and the percentage of excess weight loss (%EWL) in patients undergoing laparoscopic sleeve gastrectomy. Method: This prospective cohort study evaluated 125 patients who underwent laparoscopic sleeve gastrectomy. The MHR before and at 6 months after surgery were compared in patients with <50 and ≥50 %EWL. Results: The MHR was lower in patients with a %EWL of <50 than in patients with a %EWL of ≥50 (p = 0.019). The decrease in the MHR at postoperative 6 months was more remarkable in patients with a %EWL of ≥50 (p < 0.001). Conclusion: The present study suggests that MHR decreased more remarkably at postoperative 6 months in patients with high %EWL, predicting a decrease in cardiovascular risk.
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Affiliation(s)
- Sibel Ocak Serin
- Department of Internal Medicine, University of Health Sciences, Umraniye Training & Research Hospital, Istanbul, 34760, Turkey
| | - Abdullah Sisik
- Department of General Surgery, University of Health Sciences, Umraniye Training & Research Hospital, Istanbul, 34760, Turkey
| | - Fatih Basak
- Department of General Surgery, University of Health Sciences, Umraniye Training & Research Hospital, Istanbul, 34760, Turkey
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29
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Buch A, Marcus Y, Shefer G, Zimmet P, Stern N. Approach to Obesity in the Older Population. J Clin Endocrinol Metab 2021; 106:2788-2805. [PMID: 34406394 DOI: 10.1210/clinem/dgab359] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Indexed: 12/14/2022]
Abstract
Until recently, weight loss in older obese people was feared because of ensuing muscle loss and frailty. Facing overall increasing longevity, high rates of obesity in older individuals (age ≥ 65 years) and a growing recognition of the health and functional cost of the number of obesity years, abetted by evidence that intentional weight loss in older obese people is safe, this approach is gradually, but not unanimously, being replaced by more active principles. Lifestyle interventions that include reduced but sufficient energy intake, age-adequate protein and micronutrient intake, coupled with aerobic and resistance exercise tailored to personal limitations, can induce weight loss with improvement in frailty indices. Sustained weight loss at this age can prevent or ameliorate diabetes. More active steps are controversial. The use of weight loss medications, particularly glucagon-like peptide-1 analogs (liraglutide as the first example), provides an additional treatment tier. Its safety and cardiovascular health benefits have been convincingly shown in older obese patients with type 2 diabetes mellitus. In our opinion, this option should not be denied to obese individuals with prediabetes or other obesity-related comorbidities based on age. Finally, many reports now provide evidence that bariatric surgery can be safely performed in older people as the last treatment tier. Risk-benefit issues should be considered with extreme care and disclosed to candidates. The selection process requires good presurgical functional status, individualized consideration of the sequels of obesity, and reliance on centers that are highly experienced in the surgical procedure as well as short-term and long-term subsequent comprehensive care and support.
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Affiliation(s)
- Assaf Buch
- The Sagol Center for Epigenetics of Aging and Metabolism, Tel Aviv-Sourasky Medical Center, Tel Aviv 6423906, Israel
- The Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Yonit Marcus
- The Sagol Center for Epigenetics of Aging and Metabolism, Tel Aviv-Sourasky Medical Center, Tel Aviv 6423906, Israel
- The Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Gabi Shefer
- The Sagol Center for Epigenetics of Aging and Metabolism, Tel Aviv-Sourasky Medical Center, Tel Aviv 6423906, Israel
- The Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Paul Zimmet
- The Sagol Center for Epigenetics of Aging and Metabolism, Tel Aviv-Sourasky Medical Center, Tel Aviv 6423906, Israel
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Victoria 3004, Australia
| | - Naftali Stern
- The Sagol Center for Epigenetics of Aging and Metabolism, Tel Aviv-Sourasky Medical Center, Tel Aviv 6423906, Israel
- The Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Tan SYT, Syn NL, Lin DJ, Lim CH, Ganguly S, Ong HS, Tan JTH, Lee PC. Centile Charts for Monitoring of Weight Loss Trajectories After Bariatric Surgery in Asian Patients. Obes Surg 2021; 31:4781-4789. [PMID: 34363141 DOI: 10.1007/s11695-021-05618-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/17/2021] [Accepted: 07/20/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Following bariatric surgery, accurate charting of weight loss and regain is crucial. Various preoperative factors affect postoperative weight loss, including age, sex, ethnicity, and surgical type. These are not considered by current weight loss metrics, limiting comparison of weight loss outcomes between patients or centers and across time. METHODS Patients (n=1022) who underwent sleeve gastrectomy (n=809) and gastric bypass (n=213) from 2008 to 2020 in a single center were reviewed. Weight loss outcomes (% total weight loss) were measured for 60 months postoperatively. Longitudinal centile lines were plotted using the post-estimation predictions of quantile regression models, adjusted for type of procedure, sex, ethnicity, and baseline BMI. RESULTS Median regression showed that %TWL was 1.0% greater among males than females (β = +1.1, 95% CI: +0.6 to +1.7, P = <0.0001). Participants who underwent SG had less %TWL compared to GB (β = -1.3, 95% CI: -1.9 to -0.8, P < 0.0001). There was a trend towards less %TWL among the Indian and Malay participants compared to Chinese. Age and diabetes were not significant predictors. Reference centile charts were produced for the overall cohort, as well as specific charts adjusted for type of bariatric procedure, sex, ethnicity, and baseline BMI. CONCLUSION Centile charts provide a clinically relevant method for monitoring of weight trajectories postoperatively and aid in realistic and personalised goal setting, and the early identification of "poor responders". This is the first study to present post-bariatric surgery centile charts for an Asian cohort.
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Affiliation(s)
- Sarah Ying Tse Tan
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - Nicholas L Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Daryl J Lin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chin Hong Lim
- Department of Upper Gastrointestinal & Bariatric Surgery, Singapore General Hospital, Singapore, Singapore
- Obesity Centre, Outram Community Hospital SGH, Specialist Outpatient Clinic SingHealth Tower, Level 3, 10 Hospital Blvd, Singapore, 168582, Singapore
| | - Sonali Ganguly
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
- Obesity Centre, Outram Community Hospital SGH, Specialist Outpatient Clinic SingHealth Tower, Level 3, 10 Hospital Blvd, Singapore, 168582, Singapore
| | - Hock Soo Ong
- Department of Upper Gastrointestinal & Bariatric Surgery, Singapore General Hospital, Singapore, Singapore
| | - Jeremy Tian Hui Tan
- Department of Upper Gastrointestinal & Bariatric Surgery, Singapore General Hospital, Singapore, Singapore
- Obesity Centre, Outram Community Hospital SGH, Specialist Outpatient Clinic SingHealth Tower, Level 3, 10 Hospital Blvd, Singapore, 168582, Singapore
| | - Phong Ching Lee
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore.
- Obesity Centre, Outram Community Hospital SGH, Specialist Outpatient Clinic SingHealth Tower, Level 3, 10 Hospital Blvd, Singapore, 168582, Singapore.
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Barber D, Morkem R, Dalgarno N, Houlden R, Smith K, Anvari M, Zevin B. Patients eligible and referred for bariatric surgery in southeastern Ontario: Retrospective cohort study. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:e31-e40. [PMID: 33483411 DOI: 10.46747/cfp.6701e31] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the proportion of eligible individuals, within one health region in Ontario, who were referred for publicly funded medical and surgical weight-loss interventions (MSWLI). DESIGN A retrospective cohort study that used primary care data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) and referral data from the Ontario Bariatric Network (OBN). SETTING Primary care practices within southeastern Ontario that contribute data to CPCSSN. PARTICIPANTS Patients with class II (body mass index [BMI] 35.0 to 39.9 kg/m2) or III (BMI ≥ 40 kg/m2) obesity who were eligible for referral to the OBN for MSWLI. MAIN OUTCOME MEASURES Primary care data about patients within the CPCSSN database were linked to referral records within the OBN database using 3 indirect identifiers to determine the proportion of patients with class II and III obesity who were referred to the OBN for MSWLI. An adjusted multivariate logistic regression model was used to determine the most significant predictors of referral. RESULTS Of the 87 276 patients within one health region in Ontario, 15 526 (17.8%) patients had class II or III obesity and were eligible for referral for MSWLI. Only 966 out of those 15 526 (6.2%) patients were actually referred for MSWLI. In the multivariate regression analysis, BMI had the strongest association with referral in terms of adjusted odds ratio (AOR), varying from 2.50 (95% CI 2.04 to 3.06) for a BMI of 40.0 to 44.9 kg/m2, to 5.15 (95% CI 4.21 to 6.30) for a BMI of 50.0 kg/m2 or greater. Referral was more likely for female than male patients (AOR = 2.18; 95% CI 1.86 to 2.57), those living rurally than for urban dwellers (AOR = 1.39; 95% CI 1.20 to 1.60), and those aged 30 to 39 (AOR = 1.61; 95% CI 1.24 to 2.09) and 40 to 49 (AOR = 1.53; 95% CI 1.18 to 1.98) compared with other age groups. CONCLUSION Within one health region in Ontario, the referral rate of patients with class II and III obesity for MSWLI was low. Our findings highlight the need for further research to understand and address the barriers to referral of patients with class II and III obesity for MSWLI.
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Affiliation(s)
- David Barber
- Network Director and Assistant Professor in the Centre for Studies in Primary Care at Queen's University in Kingston, Ont
| | - Rachael Morkem
- Research associate with the Centre for Studies in Primary Care at Queen's University
| | - Nancy Dalgarno
- Education Researcher and Consultant in the Office of Health Sciences Education at Queen's University
| | - Robyn Houlden
- Professor and Chair of the Division of Endocrinology at Queen's University
| | - Karen Smith
- Professor in the Office of Health Sciences Education at Queen's University
| | - Mehran Anvari
- Professor of Surgery in the Faculty of Health Sciences at McMaster University and Chair and Clinic Lead of the Ontario Bariatric Network
| | - Boris Zevin
- Assistant Professor in the Department of Surgery at Queen's University.
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ELBASAN O, ŞİŞMAN P, PEYNİRCİ H, YABACI A, ERSOY C. The influence of gender and age on laparoscopic sleeve gastrectomy short-term outcomes in type 2 diabetic obese patients. TURKISH JOURNAL OF INTERNAL MEDICINE 2021. [DOI: 10.46310/tjim.881201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Athanasiadis DI, Hernandez E, Monfared S, Kubicki N, Ninad N, Karim A, Selzer D, Stefanidis D, Banerjee A. Bariatric surgery outcomes: is age just a number? Surg Endosc 2021; 35:3139-3146. [PMID: 32601760 DOI: 10.1007/s00464-020-07752-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 06/16/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Obesity and its associated comorbidities represent a pervasive problem in the United States across all age groups. There are conflicting data regarding the effectiveness and postoperative recovery of bariatric surgery in elderly patients. The aim of this study was to compare outcomes of bariatric surgery across age groups. MATERIALS AND METHODS After obtaining institutional review board approval, patients with morbid obesity who underwent non-revisional laparoscopic Roux-en-Y gastric bypass (LRYGB) and sleeve gastrectomy (LSG) at our institution between 2011 and 2015 were included in this retrospective study. Patients were subdivided into five age groups: < 30, 30-39, 40-49, 50-59, and ≥ 60 years. Patient baseline demographics and comorbidities were collected. Postoperative outcomes including reinterventions/reoperations, 30-day-readmissions, 90-day-mortality, comorbidities' resolution, and change in BMI (ΔBMI) up to 4 years were recorded and compared. The groups were compared with ANOVA and chi-square tests and multivariable analyses. RESULTS LRYGB was performed in 74.7% of the 1026 study patients. Patients ≥ 60 years old demonstrated lower preoperative BMI than patients < 50 years (p < 0.001). Patients 50-59 years old had increased length of stay compared to 30-39 (p = 0.003) and a higher prevalence of all comorbidities was found in older patients (p < 0.001). There was no significant difference in 30-day-readmissions; 90-day-mortality; reoperations; and reinterventions among the study groups. The ΔBMI was higher in younger patients and comorbidity resolution was more likely in younger patients with the exception of obstructive sleep apnea. CONCLUSION Bariatric surgery can be accomplished safely across all age groups with satisfiable postoperative weight loss. However, older age had higher hospital stay and convalescence and lower comorbidity resolution compared to younger patients. Thus, bariatric surgery should be offered earlier in life to allow the patients to reap its benefits.
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Affiliation(s)
- Dimitrios I Athanasiadis
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine Indiana, 11725 N Illinois St, Suite 350, Carmel, Indianapolis, IN, 46032, USA
| | - Edward Hernandez
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine Indiana, 11725 N Illinois St, Suite 350, Carmel, Indianapolis, IN, 46032, USA
| | - Sara Monfared
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine Indiana, 11725 N Illinois St, Suite 350, Carmel, Indianapolis, IN, 46032, USA
| | - Natalia Kubicki
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, University of Maryland Medical Systems, Baltimore, MD, USA
| | - Nehal Ninad
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Amani Karim
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Don Selzer
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine Indiana, 11725 N Illinois St, Suite 350, Carmel, Indianapolis, IN, 46032, USA
- Indiana University Health North Hospital, Indianapolis, IN, USA
| | - Dimitrios Stefanidis
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine Indiana, 11725 N Illinois St, Suite 350, Carmel, Indianapolis, IN, 46032, USA
- Indiana University Health North Hospital, Indianapolis, IN, USA
| | - Ambar Banerjee
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine Indiana, 11725 N Illinois St, Suite 350, Carmel, Indianapolis, IN, 46032, USA.
- Indiana University Health North Hospital, Indianapolis, IN, USA.
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Abstract
BACKGROUND Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the most frequent bariatric surgery procedures worldwide. In this prospective study, we examined the association of a genetic risk score (GRS) with loss of excess weight after bariatric surgery. METHODS A total of forty-seven morbidly obese Greek patients who underwent SG (81%) or RYGB were recruited, followed up for 2 years and genotyped. Weight loss after surgery was reported as the percentage of excess weight that was lost (%EWL) at 12 and 24 months after surgery. A GRS was constructed based on previously BMI- and WHR-related single nucleotide polymorphisms (SNPs) that were found significantly correlated with weight loss after bariatric surgery in our population. The level of post-surgery %EWL after 12 and 24 months was estimated through two multiple linear regression models that considered the effects of relevant genetic risk variants. RESULTS The first proposed model suggested that the predictor variables of GRS, age, and BMI had a significant effect on %EWL12m. GRS was significantly associated with %EWL12m, indicating a 4.618% decrease of %EWL12m per score unit. The second model indicated a positive correlation between %EWL24m and %EWL12m, suggesting that while post-surgery weight loss increased during the first 12 months, an increase was expected in the next 12 months as well. GRS was also significantly associated with %EWL24m, indicating approximately 3% decrease of %EWL24m per score unit. CONCLUSION GRS can be used in the future together with other preoperative parameters in order to predict the outcome of bariatric surgery.
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Sleeve Gastrectomy Versus Roux-en-Y Gastric Bypass in the Elderly: 1-Year Preliminary Outcomes in a Randomized Trial (BASE Trial). Obes Surg 2021; 31:2359-2363. [PMID: 33683573 DOI: 10.1007/s11695-021-05316-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Despite the increasing prevalence of elderly obese patients, bariatric surgery remains controversial in this population. Recent publications have focused on perioperative safety, but few studies have addressed clinical outcomes. OBJECTIVES This study aimed to evaluate 1-year outcomes of laparoscopic sleeve gastrectomy (LSG) compared to laparoscopic Roux-en-Y gastric bypass (LRYGB) in patients 65 years or older. METHODS Thirty-six elderly obese patients were recruited for an open-label randomized trial from September 2017 to May 2019, comparing LSG to LRYGB. One-year outcomes were evaluated based on weight loss, functionality, and control of clinical conditions. RESULTS The median age (67 × 67 years; p=0.67) and initial body mass index (BMI) (46.3 × 51.3 kg/m2; p=0.28) were similar between groups. Preoperative BMI (after weight loss pre-operative treatment) was higher in LRYGB group (41.9 × 47.6 kg/m2; p= 0.03). After 12 months, EWL and TWL were higher in LRYGB group (60 × 68%; p=0.04; 24.9 × 31.4%; p<0.01). HbA1c reduction was higher after LRYGB (-1.1 × -0.5%; p<0.01) as well as LDL control (-27.5 × +11.5 mg/dL p= 0.02). No difference was noted between LRYGB and LSG concerning hypertension control, triglycerides, HDL, and functionality. CONCLUSION Weight loss, diabetes, and LDL control were better achieved with LRYGB after 12 months.
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Keshavjee SH, Schwenger KJP, Yadav J, Jackson TD, Okrainec A, Allard JP. Factors Affecting Metabolic Outcomes Post Bariatric Surgery: Role of Adipose Tissue. J Clin Med 2021; 10:714. [PMID: 33670215 PMCID: PMC7916950 DOI: 10.3390/jcm10040714] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/07/2021] [Accepted: 02/09/2021] [Indexed: 02/07/2023] Open
Abstract
Obesity is an ever-growing public health crisis, and bariatric surgery (BS) has become a valuable tool in ameliorating obesity, along with comorbid conditions such as diabetes, dyslipidemia and hypertension. BS techniques have come a long way, leading to impressive improvements in the health of the majority of patients. Unfortunately, not every patient responds optimally to BS and there is no method that is sufficient to pre-operatively predict who will receive maximum benefit from this surgical intervention. This review focuses on the adipose tissue characteristics and related parameters that may affect outcomes, as well as the potential influences of insulin resistance, BMI, age, psychologic and genetic factors. Understanding the role of these factors may help predict who will benefit the most from BS.
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Affiliation(s)
- Sara H. Keshavjee
- Vagelos College of Physicians & Surgeons, Columbia University, New York, NY 10032, USA;
| | - Katherine J. P. Schwenger
- Division of Gastroenterology, Toronto General Hospital, University Health Network, Toronto, ON M5G 2N2, Canada;
| | - Jitender Yadav
- Department of Immunology, University of Toronto, Toronto, ON M5S 1A8, Canada;
| | - Timothy D. Jackson
- Division of General Surgery, University Health Network, University of Toronto, Toronto, ON M5T 2S8, Canada; (T.D.J.); (A.O.)
| | - Allan Okrainec
- Division of General Surgery, University Health Network, University of Toronto, Toronto, ON M5T 2S8, Canada; (T.D.J.); (A.O.)
| | - Johane P. Allard
- Division of Gastroenterology, Toronto General Hospital, University Health Network, Toronto, ON M5G 2N2, Canada;
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Bianciardi E, Raimondi G, Samela T, Innamorati M, Contini LM, Procenesi L, Fabbricatore M, Imperatori C, Gentileschi P. Neurocognitive and Psychopathological Predictors of Weight Loss After Bariatric Surgery: A 4-Year Follow-Up Study. Front Endocrinol (Lausanne) 2021; 12:662252. [PMID: 34025579 PMCID: PMC8131828 DOI: 10.3389/fendo.2021.662252] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/30/2021] [Indexed: 11/13/2022] Open
Abstract
Twenty to thirty percent of patients experience weight regain at mid and long-term follow-up. Impaired cognitive functions are prevalent in people suffering from obesity and in those with binge eating disorder, thereby, affecting the weight-loss outcomes. The aim of our study was to investigate neurocognitive and psychopathological predictors of surgical efficacy in terms of percentage of excess weight loss (%EWL) at follow-up intervals of one year and 4-year. Psychosocial evaluation was completed in a sample of 78 bariatric surgery candidates and included psychometric instruments and a cognitive battery of neuropsychological tests. A schedule of 1-year and 4-year follow-ups was implemented. Wisconsin Sorting Card Test total correct responses, scores on the Raven's Progressive Matrices Test, and age predicted %EWL at, both, early and long-term periods after surgery while the severity of pre-operative binge eating (BED) symptoms were associated with lower %EWL only four years after the operation. Due to the role of pre-operative BED in weight loss maintenance, the affected patients are at risk of suboptimal response requiring ongoing clinical monitoring, and psychological and pharmacological interventions when needed. As a result of our findings and in keeping with the latest guidelines we encourage neuropsychological assessment of bariatric surgery candidates. This data substantiated the rationale of providing rehabilitative interventions tailored to cognitive domains and time specific to the goal of supporting patients in their post-surgical course.
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Affiliation(s)
- Emanuela Bianciardi
- Psychiatric Chair, Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
- *Correspondence: Emanuela Bianciardi,
| | - Giulia Raimondi
- Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Rome, Italy
| | - Tonia Samela
- Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Rome, Italy
| | - Marco Innamorati
- Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Rome, Italy
| | - Lorenzo Maria Contini
- Psychiatric Chair, Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Leonardo Procenesi
- Psychiatric Chair, Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Mariantonietta Fabbricatore
- Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Rome, Italy
| | - Claudio Imperatori
- Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Rome, Italy
| | - Paolo Gentileschi
- Obesity Unit, Department of Surgery, University of Rome “Tor Vergata”, Rome, Italy
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Mendonça F, Silva MM, Salazar D, Ferreira MJ, Pedro J, Guerreiro V, Viana S, Neves JS, Belo S, Varela A, Freitas P, Carvalho D. Bariatric Surgery Impact on Cardiovascular Risk Factors: Is Age a Factor to Consider? Obes Facts 2021; 14:72-77. [PMID: 33321490 PMCID: PMC7983533 DOI: 10.1159/000511737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/18/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Despite the abundance of data addressing the influence of patient's age on surgery-related complications, its impact on cardiometabolic outcomes following bariatric surgery has been overlooked. METHODS Retrospective unicentric study of 1,728 obese patients who underwent bariatric surgery between January 2010 and June 2015. Patients were divided in 3 age groups, according to their age at surgery: ˂40 (n = 751), 40-59 (n = 879), and ≥60 years (n = 98). Parameters with cardiometabolic impact, such as body anthropometric measures, lipid profile, and glycemic status, before and 24 months after surgery, were compared between these groups. A multiple linear regression was performed, adjusting differences between groups for sex, surgery type, and body mass index variation. RESULTS The group ˂40 years presented more weight loss (-35.4 ± 9.0 kg, p ˂ 0.001), greater BMI reduction (-15.8 ± 6.1 kg/m2, p ˂ 0.001), and larger changes in waist (-34 ± 13.8 cm, p ˂ 0.001) and hip circumferences (-28.7 ± 11.9 cm, p ˂ 0.05). The group of ≥60 years presented the heaviest reduction in fasting glucose (-17.7 ± 32.8 mg/dL, p ˂ 0.001) and HbA1c (0.7 ± 1.0, p ˂ 0.001), and also had a tendency to have the biggest changes in systolic blood pressure (-14.7 ± 18.7 mm Hg, p = 0.071). CONCLUSION Patients with ≥60 years benefit the most from bariatric surgery regarding cardiometabolic parameters, presenting heavier reductions in fasting glucose, as well as HbA1c and a tendency towards a higher decrease in systolic blood pressure. No clinically significant differences in lipid profile were observed between groups.
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Affiliation(s)
- Fernando Mendonça
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal,
- Faculty of Medicine, Universidade do Porto, Porto, Portugal,
| | - Maria Manuel Silva
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Daniela Salazar
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Maria João Ferreira
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Jorge Pedro
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Vanessa Guerreiro
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Sara Viana
- Unidade Local de Saúde do Norte Alentejano EPE, Évora, Portugal
| | - Joao Sérgio Neves
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal
| | - Sandra Belo
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal
| | - Ana Varela
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal
| | - Paula Freitas
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal
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Li S, Jiao S, Zhang S, Zhou J. Revisional Surgeries of Laparoscopic Sleeve Gastrectomy. Diabetes Metab Syndr Obes 2021; 14:575-588. [PMID: 33603423 PMCID: PMC7882429 DOI: 10.2147/dmso.s295162] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/08/2021] [Indexed: 12/11/2022] Open
Abstract
Bariatric surgery has become increasingly common due to the worldwide obesity epidemic. A shift from open to laparoscopic surgery, specifically, laparoscopic sleeve gastrectomy (LSG), has occurred in the last two decades because of the low morbidity and mortality rates of LSG. Although LSG is a promising treatment option for patients with morbid obesity due to restrictive and endocrine mechanisms, it requires modifications for a subset of patients because of weight regain and tough complications, such as gastroesophageal reflux, strictures, gastric leak, and persistent metabolic syndrome., Revision surgeries have become more and more indispensable in bariatric surgery, accounting for 7.4% in 2016. Mainstream revisional bariatric surgeries after LSG include Roux-en-Y gastric bypass, repeated sleeve gastrectomy, biliopancreatic diversion, duodenal switch, duodenal-jejunal bypass, one-anastomosis gastric bypass, single anastomosis duodeno-ileal bypass (SAID) and transit bipartition. This review mainly describes the revisional surgeries of LSG, including the indication, choice of surgical method, and subsequent effect.
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Affiliation(s)
- Siyuan Li
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People’s Republic of China
| | - Siqi Jiao
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People’s Republic of China
| | - Siwei Zhang
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People’s Republic of China
| | - Jiangjiao Zhou
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People’s Republic of China
- Correspondence: Jiangjiao Zhou Department of General Surgery, The Second Xiangya Hospital, Central South University, No. 139 Middle Renmin Road, Changsha, Hunan, 410011, People’s Republic of China Email
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Woźniewska P, Diemieszczyk I, Groth D, Szczerbiński Ł, Choromańska B, Błachnio-Zabielska A, Krętowski A, Hady HR. The influence of patient's age on metabolic and bariatric results of laparoscopic sleeve gastrectomy in 2-year observation. BMC Surg 2020; 20:323. [PMID: 33298009 PMCID: PMC7727122 DOI: 10.1186/s12893-020-00989-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 11/29/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The incidence of obesity has been constantly growing and bariatric procedures are considered to be the most effective treatment solution for morbidly obese patients. The results of laparoscopic sleeve gastrectomy (LSG) may differ depending on patient's age, gender, preoperative body mass index (BMI) and physical activity. METHODS The aim of this study was to evaluate age-related differences in the outcome of LSG in terms of weight loss parameters, lipid and carbohydrate profile. The retrospective analysis of 555 patients who had undergone LSG was performed to compare the metabolic outcomes of surgery in individuals < 45 and ≥ 45 years old. Evaluation of weight loss parameters along with selected laboratory data was performed to demonstrate the results of LSG in 2 years follow-up. RESULTS Overall, 238 males and 317 females (43%/57%) with median age of 43 years and median preoperative BMI of 46.41 (42.06-51.02) kg/m2 were analyzed. Patients in both groups presented significant weight loss at 24 months after the surgery with comparable percentage of total weight loss (40.95% in < 45 years old group and 40.44% in ≥ 45 years old group). The percentage of excess weight loss (78.52% vs. 74.53%) and percentage of excess BMI loss (91.95% vs. 88.01%) were higher in patients < 45 years old. However, the differences were not statistically significant (p = 0.662, p = 0.788 respectively). Patients under 45 years old experienced faster decrease in fasting glucose level that was observed after only 3 months (109 mg/dl to 95 mg/dl in < 45 years old group vs. 103.5 mg/dl to 99.5 mg/dl in ≥ 45 years old group, p < 0.001). Both groups presented improvement of lipid parameters during the observation. However, patients < 45 years old achieved lower values of LDL at 3 and 12 months follow-up (115 mg/dl vs. 126 mg/dl, p = 0.010; 114.8 mg/dl vs. 122 mg/dl, p = 0.002). Younger group of patients also showed superior improvement of triglycerides level. CONCLUSIONS LSG results in significant weight loss in all patients regardless age. In turn, superior and faster improvement in lipid and carbohydrate profile is achieved in patients under 45 years old.
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Affiliation(s)
- Paulina Woźniewska
- 1St Department of General and Endocrine Surgery, Medical University of Bialystok, ul. Marii Skłodowskiej-Curie 24A, 15-276, Bialystok, Poland.
| | - Inna Diemieszczyk
- 1St Department of General and Endocrine Surgery, Medical University of Bialystok, ul. Marii Skłodowskiej-Curie 24A, 15-276, Bialystok, Poland
| | - Dawid Groth
- Eastern Center of the Burns Treatment and Reconstructive Surgery, Independent Public Health Care Center in Łeczna, Łęczna, Poland
| | - Łukasz Szczerbiński
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Barbara Choromańska
- 1St Department of General and Endocrine Surgery, Medical University of Bialystok, ul. Marii Skłodowskiej-Curie 24A, 15-276, Bialystok, Poland
| | | | - Adam Krętowski
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Hady Razak Hady
- 1St Department of General and Endocrine Surgery, Medical University of Bialystok, ul. Marii Skłodowskiej-Curie 24A, 15-276, Bialystok, Poland
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Variables Associated with Short-Term Weight Loss in a Cohort of Patients with Morbid Obesity According to Age and Three Types of Bariatric Surgery. J Clin Med 2020; 9:jcm9113537. [PMID: 33147793 PMCID: PMC7692348 DOI: 10.3390/jcm9113537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 11/26/2022] Open
Abstract
Background The percentage of excess weight lost (%EWL) after bariatric surgery (BS) shows great discrepancies from one individual to another. Objective To evaluate the %EWL one year after BS and to determine the existence of baseline biomarkers associated with weight loss. Methods We studied 329 patients with morbid obesity undergoing three types of BS (biliopancreatic diversion (BPD), Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG)), depending on the %EWL one year after surgery: good responders (GR) (%EWL ≥ 50%) and non-responders (NR) (%EWL < 50%). Results The GR presented a higher percentage of change in anthropometric and biochemical variables compared to the NR group, even within each type of BS. There was a greater percentage of GR among those who underwent RYGB. The patients who underwent SG showed the lowest decrease in biochemical variables, both in GR and NR. Within the GR group, those with a lower age showed greater improvement compared to the other age groups. A %EWL ≥50% was negatively associated with the age and atherogenic index of plasma (AIP), and positively with the type of BS (RYGB). Conclusions The GR group was associated with lower age and AIP and undergoing RYGB. Additionally, those patients who underwent SG showed a lower metabolic improvement.
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Jirapinyo P, de Moura DTH, Horton LC, Thompson CC. Effect of Aspiration Therapy on Obesity-Related Comorbidities: Systematic Review and Meta-Analysis. Clin Endosc 2020; 53:686-697. [PMID: 32106362 PMCID: PMC7719414 DOI: 10.5946/ce.2019.181] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/31/2019] [Accepted: 11/05/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/AIMS Aspiration therapy (AT) involves endoscopic placement of a gastrostomy tube with an external device that allows patients to drain 30% of ingested calories after meals. Its efficacy for inducing weight loss has been shown. This study aimed to assess the effect of AT on obesity-related comorbidities. METHODS A meta-analysis of studies that assessed AT outcomes was conducted through December 2018. Primary outcomes were changes in comorbidities at 1 year following AT. Secondary outcomes were the amount of weight loss at up to 4 years and pooled serious adverse events (SAEs). RESULTS Five studies with 590 patients were included. At 1 year, there were improvements in metabolic conditions: mean difference (MD) in systolic blood pressure: -7.8 (-10.7 - -4.9) mm Hg; MD in diastolic blood pressure: -5.1 (-7.0 - 3.2) mm Hg; MD in triglycerides: -15.8 (-24.0 - -7.6) mg/dL; MD in high-density lipoprotein: 3.6 (0.7-6.6) mg/dL; MD in hemoglobin A1c (HbA1c): -1.3 (-1.8 - -0.8) %; MD in aspartate transaminase: -2.7 (-4.1 - -1.3) U/L; MD in alanine transaminase: -7.5 (-9.8 - -5.2) U/L. At 1 (n=218), 2 (n=125), 3 (n=46), and 4 (n=27) years, the patients experienced 17.8%, 18.3%, 19.1%, and 18.6% total weight loss (TWL), corresponding to 46.3%, 46.2%, 48.0%, and 48.7% excess weight loss (EWL) (p<0.0001 for all). Subgroup analysis of 2 randomized controlled trials (n=225) showed that AT patients lost more weight than did controls by 11.6 (6.5-16.7) %TWL and 25.6 (16.0-35.3) %EWL and experienced greater improvement in HbA1c and alanine transaminase by 1.3 (0.8-1.8) % and 9.0 (3.9-14.0) U/L. The pooled SAE rate was 4.1%. CONCLUSION Obesity-related comorbidities significantly improved at 1 year following AT. Additionally, a subgroup of patients who continued to use AT appeared to experience significant weight loss that persisted up to at least 4 years.
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Affiliation(s)
- Pichamol Jirapinyo
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, MA, USA
| | - Diogo T. H. de Moura
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, MA, USA
| | - Laura C. Horton
- Department of Internal Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Christopher C. Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, MA, USA
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Ponce de León-Ballesteros G, Sánchez-Aguilar HA, Velázquez-Fernández D, Nava-Ponce T, Herrera MF. Roux-en-Y Gastric Bypass in Patients >60 Years of Age: Morbidity and Short-Term Outcomes. Obes Surg 2020; 30:5033-5040. [PMID: 32902775 DOI: 10.1007/s11695-020-04957-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Obesity is a common disease in the elderly population, and bariatric surgery is the most effective intervention to achieve significant and sustainable weight loss. Many bariatric programs have established an arbitrary cutoff at the age of 60 to 65 years. The aim of this study was to evaluate the safety and short-term outcomes of Roux-en-Y gastric bypass (RYGB) in patients older than 60 years. PATIENTS AND METHODS We conducted a retrospective cohort study of patients who underwent RYGB from 2004 to 2019 in a single center. Logistic and linear multivariate regressions were made to compare complications and short-term outcomes between patients aged > 60 years and < 60 years. The statistical significance was set at p ≤ 0.05. RESULTS From 849 patients who underwent a primary RYGB, 57 were > 60 years of age. Overall, early and late complications were similar in both groups, except for unexpected intensive care unit (ICU) admission which was more frequent in the > 60 years group. Excess body weight loss (%EWL) and percentage total weight loss (%TWL) at 1 year in patients > 60 years old were 76.6 ± 21.8% and 30.73 ± 6.8%, respectively. Figures for the same parameters in the control group were 81.7 ± 19.9% (p = 0.09) and 34.3 ± 7.2 (p = 0.001), respectively. CONCLUSIONS In our experience, an age > 60 is not related to higher rates of overall early and late complications after RYGB. Comorbidity remission rates are similar to those in younger patients. Elderly patients had lower total weight loss at 1 year, but the %EWL was similar in both groups.
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Affiliation(s)
| | - Hugo A Sánchez-Aguilar
- Clinic for Nutrition and Obesity, ABC Medical Center, 116, Sur 136, Las Américas, Álvaro Obregón, 01120, Mexico City, Mexico
| | - David Velázquez-Fernández
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Tania Nava-Ponce
- Clinic for Nutrition and Obesity, ABC Medical Center, 116, Sur 136, Las Américas, Álvaro Obregón, 01120, Mexico City, Mexico
| | - Miguel F Herrera
- Clinic for Nutrition and Obesity, ABC Medical Center, 116, Sur 136, Las Américas, Álvaro Obregón, 01120, Mexico City, Mexico. .,Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
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Jacobson R, Terranella S, Booker C, Khalid S, Torquati A, Omotosho P. The Impact of Perioperative Antibiotic Prophylaxis on Weight Loss Following Laparoscopic Sleeve Gastrectomy. J Laparoendosc Adv Surg Tech A 2020; 30:998-1000. [DOI: 10.1089/lap.2020.0449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Richard Jacobson
- Department of Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Samantha Terranella
- Department of Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Connor Booker
- Department of Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Syed Khalid
- Department of Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Alfonso Torquati
- Department of Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Philip Omotosho
- Department of Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Turchi MJ, Kingma F, Laborda N, Montanelli A, Maldonado JM, Fiolo FE. Roux-en-Y gastric bypass in the elderly: is age a determining factor in our outcomes? Surg Obes Relat Dis 2020; 16:1514-1520. [PMID: 32665112 DOI: 10.1016/j.soard.2020.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/16/2020] [Accepted: 05/12/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND While patients are becoming older and the prevalence of obesity increases worldwide, literature on the impact of age on outcomes after laparoscopic Roux-en-Y gastric bypass (LRYGB) is scarce. The balance between surgical risks and clinical benefits of LRYGB are unclear in relation to age. OBJECTIVES To evaluate the impact of age on the risk of postoperative complications, postoperative weight loss, and remission of co-morbidities for patients who underwent LRYGB. SETTING A high-volume center for bariatric surgery. METHODS A retrospective analysis of 582 patients who underwent LRYGB was performed. Linear logistic regression analyses were performed to evaluate the potential impact of age on the postoperative percentage of total weight loss (%TWL). Multivariable binary logistic regression analyses were performed to evaluate whether age was independently associated with the risk of postoperative complications and likelihood of remission of co-morbidities (hypertension, diabetes, and dyslipidemia). In addition, these outcomes were descriptively analyzed for the following 3 age groups: the young (18-39 yr), the middle aged (40-59 yr), and the elderly (≥60 yr). RESULTS Patients with hypertension were more prone to developing postoperative complications (odds ratio 2.435, 95% confidence interval: 1.241-4.777) and no other factors were found to be associated with the risk of postoperative complications. Older age was significantly associated with lower %TWL at a postoperative follow-up of 6 (ß = -.117, P = .004), 12 (ß = -.177, P < .001), and 36 months (ß = -.169, P = .001), but not at 60 months (ß = -.097, P = .161). Nonetheless, a %TWL of 30% was observed in patients who were >60 years at the time of surgery. Age was not associated with the likelihood of co-morbidity resolution after LRYGB. The remission of hypertension was less likely in patients with co-existence of diabetes (odds ratio .334, 95% confidence interval: .136-.821) and in patients with a longer length of postoperative follow-up (odds ratio .982, 95% confidence interval: .966-.998). CONCLUSIONS Although older age seems to be associated with lower postoperative %TWL, elderly patients can still achieve a %TWL of 30% after LRYGB. In this study, age was not found to be an independent predictor of postoperative complications nor the likelihood of co-morbidity resolution. Therefore, older age alone should not be an absolute contraindication for LRYGB.
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Affiliation(s)
- Matías J Turchi
- Bariatric and Metabolic Surgery Section, Department of General Surgery, Hospital Privado de Comunidad, Mar del Plata, Argentina.
| | - Feike Kingma
- University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - Nicolás Laborda
- Bariatric and Metabolic Surgery Section, Department of General Surgery, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Agostina Montanelli
- Bariatric and Metabolic Surgery Section, Department of General Surgery, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Juan M Maldonado
- Bariatric and Metabolic Surgery Section, Department of General Surgery, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Felipe E Fiolo
- Bariatric and Metabolic Surgery Section, Department of General Surgery, Hospital Privado de Comunidad, Mar del Plata, Argentina
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Changes in Body Composition, Comorbidities, and Nutritional Status Associated with Lower Weight Loss After Bariatric Surgery in Older Subjects. Obes Surg 2020; 29:3589-3595. [PMID: 31240537 DOI: 10.1007/s11695-019-04037-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND To provide greater insight into bariatric surgery outcomes in aging patients, we compared changes in body weight, body composition, obesity-related comorbidities, and nutritional status between older and younger subjects. METHODS We analyzed data collected between January 2004 and December 2014 from our prospective bariatric cohort. Older patients (OP, ≥ 60 years at the time of surgery, n = 93; 66% Roux-en-Y gastric bypass, 34% sleeve gastrectomy) were compared with younger patients (YP, < 60 years, n = 186), matched 1:2 on sex, body mass index, diabetes, and surgical procedure. Body composition was assessed by dual-energy X-ray absorptiometry. RESULTS Weight loss and excess weight loss at 12 months were lower in OP vs. YP (mean ± SD, 30.1 ± 10.1 vs. 34.1 ± 11.9 kg, 60.6 ± 21.2 vs. 66.8 ± 23.4%, respectively, p < 0.05 for both). Both lean body mass and fat mass loss were lower in OP vs. YP (8.4 ± 3.4 vs. 9.2 ± 9.0 kg, 19.4 ± 8.7 vs. 21.9 ± 9.1 kg, respectively, p < 0.05). The remission rate for type 2 diabetes was significantly lower in OP vs. YP (24 vs. 45%), as well as improvement in hypertension (14 vs. 46%), dyslipidemia (27 vs. 47%), and knee pain. There was no difference in micronutrient deficiencies between groups. CONCLUSIONS These data indicate that although bariatric surgery is not as effective for weight loss in older as in younger subjects, it is a safe option regarding a comprehensive set of nutritional variables which enables significant improvement in obesity-related outcomes.
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Bakr AA, Fahmy MH, Elward AS, Balamoun HA, Ibrahim MY, Eldahdoh RM. Analysis of Medium-Term Weight Regain 5 Years After Laparoscopic Sleeve Gastrectomy. Obes Surg 2020; 29:3508-3513. [PMID: 31175557 DOI: 10.1007/s11695-019-04009-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Some patients fail to maintain weight loss after bariatric surgery. Weight regain (WR) disturbs the patients due to possible reappearance of obesity-related comorbidities. This study aimed to assess WR 5 years after laparoscopic sleeve gastrectomy (LSG). PATIENTS AND METHODS This retrospective study included 100 adults who underwent LGS. The percentage of excess weight loss (%EWL) was recorded. WR was defined as an increase of at least 10% of the lowest postoperative weight. Patients with WR were subjected to CT gastric volumety. Eating behavior was assessed by the Three-Factor Eating Questionnaire-Revised 18-Items (TFEQ-R18). RESULTS Preoperative comorbidities improved in 89.5% of the patients. Twenty-five females (32.5%) got pregnant within 3 years after surgery. Age, maximum weight loss, and uncontrolled and emotional eating scales of the TFEQ-R18 were independently affecting %EWL. Also, pregnancy negatively affected %EWL. Fourteen patients regain weight: 11 females and three males. CT volumetry of the 14 patients showed a median stomach volume of 515 mL (range 172-1066 mL). CT estimated gastric volume was negatively correlated with % EWL (r = - 0.674, p = 0.008). Patients who developed WR were significantly older (p = 0.006), with lower maximum weight loss, and having higher scores of uncontrolled and emotional eating scales of TFEQ-R18. CONCLUSION Medium-term postsurgical weight regain and unsuccessful weight loss in patients who had undergone LSG is associated with older age, maladaptive eating behavior, larger residual stomach, and pregnancy.
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Affiliation(s)
- Ashraf A Bakr
- Department of Surgery, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt
| | - Mohamed H Fahmy
- Department of Surgery, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt
| | - Athar S Elward
- Department of Surgery, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt
| | - Hany A Balamoun
- Department of Surgery, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt.
| | - Mohamed Y Ibrahim
- Department of Surgery, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt
| | - Ramy M Eldahdoh
- Department of Surgery, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt
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Kaniel O, Szold A, Sakran N, Kessler Y, Langer P, Ben-Porat T, Moran-Gilad J, Sherf-Dagan S. The rise of one anastomosis gastric bypass: insights from surgeons and dietitians. Updates Surg 2020; 73:649-656. [PMID: 32451836 DOI: 10.1007/s13304-020-00805-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/16/2020] [Indexed: 11/29/2022]
Abstract
One anastomosis gastric bypass/Mini Gastric Bypass (OAGB/MGB) is an emerging bariatric surgery (BS) technique. We evaluated and compared attitudes of bariatric surgeons and dietitians towards the considerations for choosing BS-type ("Decision-making"), the contributing factors to the rise of OAGB/MGB in Israel ("OAGB/MGB-rise") and notions regarding the occurrence of gastrointestinal (GI) symptoms and nutritional deficiencies following OAGB/MGB. Anonymous online surveys were distributed. The participants were asked to rate by a 10-point Likert scale (0 = not at all; 100 = very much/often) their attitudes towards "Decision-making", "OAGB/MGB-rise" and occurrence of GI symptoms and nutritional deficiencies following OAGB/MGB. For "Decision-making" and "OAGB/MGB-rise", items were considered prioritized where ≥ 50% of the group considered them as 'very-important' (rating ≥ 80). Data on age, sex, years-in-practice and main workplace were also collected. A total of 106 professionals participated in the survey (42 surgeons; 64 dietitians). The respective mean age, years-in-practice and sex were 52.3 ± 8.7 vs. 42.3 ± 9.0 years, 21.0 ± 10.8 vs. 15.5 ± 9.2 years and 85.7% vs. 3.1% males. The inter-observer agreement for prioritized items related to "Decision-making" was fair (Kappa = 0.250; P = 0.257) and both groups prioritized patient's BMI, comorbidities and compliance. The inter-observer agreement for prioritized items related to "OAGB/MGB-rise" was moderate (Kappa = 0.550; P = 0.099) and both groups prioritized ease of performance, shorter operation duration and failure of former restrictive BS. Surgeons reported lower occurrence of nutritional deficiencies and GI symptoms as adverse effects of OAGB/MGB (P ≤ 0.033). The study highlights the views of bariatric surgeons and dietitians concerning factors that underpin the rise of OABG/MGB in Israel and possible rates of GI symptoms and nutritional deficiencies associated with this modality.
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Affiliation(s)
- Osnat Kaniel
- Department of Health Systems Management, Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Amir Szold
- Assia Medical Group, Assuta Medical Center, Tel-Aviv, Israel
| | - Nasser Sakran
- Assia Medical Group, Assuta Medical Center, Tel-Aviv, Israel.,Department of Surgery A, Emek Medical Center, Afula, Israel.,Rappaport, Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Yafit Kessler
- Assia Medical Group, Assuta Medical Center, Tel-Aviv, Israel
| | - Peter Langer
- Assia Medical Group, Assuta Medical Center, Tel-Aviv, Israel
| | - Tair Ben-Porat
- Department of Nutrition, Hadassah-Hebrew University Medical Center, Ein-Kerem Campus, Jerusalem, Israel.,Department of Human Metabolism and Nutrition, Braun School of Public Health, Hebrew University, Jerusalem, Israel
| | - Jacob Moran-Gilad
- Department of Health Systems Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shiri Sherf-Dagan
- Department of Nutritional Sciences, School of Health Sciences, Ariel University, Ariel, Israel. .,Department of Nutrition, Assuta Medical Center, Tel Aviv, Israel.
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49
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Martinaitis L, Tuero C, Fortún Landecho M, Cienfuegos JA, Moncada R, Rotellar F, Silva C, Frühbeck G, Valentí V. The long-term benefits of bariatric surgery in elderly and super-obese populations. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 111:371-377. [PMID: 30829531 DOI: 10.17235/reed.2019.5917/2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE to assess the long-term benefits of bariatric surgery in super-obese (body mass index [BMI] ≥ 50) and in elderly obese (age > 60 years) populations. METHODS one hundred and twenty one patients who underwent laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy in a university hospital were retrospectively subdivided into the following groups: BMI < 50 vs ≥ 50 and age < 60 vs ≥ 60 years. Weight loss, body composition and comorbidity outcomes were registered after one and six months and one, two, three and five years with 100%, 93%, 89%, 80%, 75% and 60% successful follow-up. RESULTS the percentage of excess BMI loss (%EBMIL) was comparable between BMI groups and age groups and the difference in the long-term follow up was not statistically significant (p > 0.05). Complication rates, comorbidity resolution, reduction in body fat and increase in fat-free mass were comparable between BMI groups and age groups. Gastric bypass resulted in a greater weight loss compared to sleeve gastrectomy. The % EBMIL was 65.2% vs 46.7% (p = 0.002), 65.8% vs 44.9% (p = 0.004), 64.4% vs 30.5% (p = 0.001), 55.6% vs 17.6% (p = 0.016) at one, two, three and five years postoperative, respectively. Similarly, in the super-obese group, weight loss was more pronounced after gastric bypass versus sleeve gastrectomy. CONCLUSIONS bariatric surgery in super-obese and elderly populations is an effective and safe weight loss measure with a good comorbidity resolution in the long-term. Gastric bypass is superior to sleeve gastrectomy in terms of long-term weight loss and comorbidity resolution in all the groups investigated.
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Affiliation(s)
| | - Carlota Tuero
- General Surgery, Clínica Universidad de Navarra, España
| | | | | | - Rafael Moncada
- Department of Anesthesiology, Clínica Universidad de Navarra
| | | | - Camilo Silva
- Department of Endocrinology, Clínica Universidad de Navarra, España
| | - Gema Frühbeck
- Department of Endocrinology, Clínica Universidad de Navarra, España
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50
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Tankel J, Shlezinger O, Neuman M, Ahuva Hershko Moshe A, Ben Nachum N, Hurvitz N, Spira R. Predicting Weight Loss and Comorbidity Improvement 7 Years Following Laparoscopic Sleeve Gastrectomy: Does Early Weight Loss Matter? Obes Surg 2020; 30:2505-2510. [DOI: 10.1007/s11695-020-04462-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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